530 SW EVERETT MALL WAY BASE FILE 2018-01-02 MF Import

F1,4,1e-Jil' DateLO�iL Application For PUBLIC WORKS PE M OCT Print or Type Only 1�4aipng Applicant Project Address (if known) HUM 061994 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,„,........................ CITY OF EVERETT Address City Attach four (4) copies of plans for proposed work - Draw to scale • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities Public Works Permit+ Bldg. Door. + Public Works Fee S Total Fee Less AOpt Fee Paid S a Balance Due S Zip Phone note the following as applicable: • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs. in advance- phone 259.881 O. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. Z Zt> 6e �re �r�C4.,S 4�J�rof/e0� oh /o-/O-y5`- y Z2re7i' P!/lSLiG O a FINAL INSPECTION Date Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street �. Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less :he City of Everett from any and all claims for damages. costs.. expenses. or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto apPhed for and further agrees to remove same upon notice from the City and to replace Public property damaged thereby. a ti Signature of Applica Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. U;