2731 FEDERAL AVE 2018-01-02 MF Import

Dated av,�l-6-7 Application For PUBLIC WORKS PERivilT Print or Type Only City &we Applicant Mailing Addres Describe Proposed Work M Pubhr. Works Pe,md> 3 Bldg. Dept. • _� Public Works Fee S Total Fee Less APpL Fee Paid $ Balance Due $ 35� W Project Address (if known) 1731 Attach four (4) copies of plans for proposed work - Draw to scale and note the foflowing as applicable: • Property Lines • Centerline of sitvet • Outline and dimensions of all existing and • Indicate North Proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS O 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. 2. All work shall be performed in accordance with this City Everett 'r permit and current of Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hr& before you dig. TOLL FREE NUMBER 1-800-424.5555. z r%S /S r9 AFC 9PPz1e1PV1S CAEa, O To ?;; is Fi9CT� T//E f%�.�iC.ShIT AC NOT �q�,��o T I4%SX.V46 199,ee1,V6'- O a Approved as Constructed everett PUBLIC V:ORKS DEPARTMENT 3200 Cedar Street Everett, WA 98207 Pilo.!P: 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 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 VIlerly damaged thereby. SigatuntcanI Date WORK A ZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP 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.