9800 EVERGREEN WAY 2018-01-02 MF Import

Datec) -I - 7 Application For PUBLIC WORKS PERMIT Print or Type Only Address Describe Proposed Work f Public Works Permit BIER. Dept. r Public Works Fee $ Total Fee Less Appt Fee Paid $ 9alance Due $ Phone Zip F'none Project Address (if known) R Do E d to r q, t e e Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • ihow any proposed grading changes • Existing and proposed utilities • how measurements no NOT WRITE BELOW THIS LINE PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. 2. All %rork 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. for Construction Date FINAL INSPECTION Date Approved as Constructed 16 PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 9820. Phone: 259.8815 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 damagescosts, 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 damarad thereby. Signature of Applicant 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 Dt1YS DURATION.