9630 EVERGREEN WAY 2018-01-02 MF Import

Date4wl- �" Application For PUBLIC WORKS PERMIT Print or Type Only Describe Proposed Work Public Works Permit eldg. eePl. PubT k. WorFeo $ — Total " Less POP'. Fee Paid s0:y(%L aelance Uue ._ City Zip Phone Mailing Address y L ) 33/6r.t`'I�S�v �v�,,t„�o� t !1 7yc fa r'.• t f'i fP/ I/ CdY Zip Phone 3 c7 y 7/ P 7 Mailing Address Project Address (if known)—< Attach four (4) copies of plans for proposed work t' Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. tt Design and Construction 2. All work shall be performed in accordance with this perm't and current City of Evere Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424.55 . i me nstruction _ XI sS— 1pproved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett. WA 98201 Phone: 259.8810 z O Y / O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the 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 applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Date Signature of Applicant 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.