9630 EVERGREEN WAY 2018-01-02 MF Import

Date 15-20—052' Application For PUBLIC WORKS PERMIT Print or Type Only 66-l9 -8 6 Public Works Permit a Bldg Dept Pubic Works Fee Total Fee $ Less Aunt. Fee Paid $ Balance Due $ �� Pz�•-W/OB3 Phone .ji I - Phone Describe Proposed Work /r Prolecc Address (if known) Attach four (4) copies of plans for proposed work • Draw to scale and note • Property Lines • Outline and dimensions of all existing and proposed structures or. the lot • Existing and proposed utilities following as applicable: • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 Itrs, in advance- phone 259-8810. 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 Under round Service 48 hrs. before y� j dig. TOLL FREE NUMBER 1-800-424-5555. W H 0 z 0 0 a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save har less the City of Everett from any and all claims for damages, cost expenses, or causes of action that may arise because of installati n and maintenance of the improvement or other right -of-way use here c applied for and further agrees to remove same upon notice from the City and or replace public operly damaged thereby. h Approv r Conslrrr -- Date 7 9�f t� /f F L EC 10 Date Approved as Constro ed ature of Applicant / Date WOR U HORIZED Y THIS PERMIT MUST BE STARTED WITHIN everett PUBLIC WORKS DEPARTMENT DA F DATE 'PERMIT IS ISSUED AND THEREAFTER IS TO 3200 Cedar Street EE DILIGE LY PURSUED TO COMPLETION. THIS PERMIT MAY BE FE Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone: 259-8810 PROJECT OVER 90 DAYS DURATION.