3424 FEDERAL AVE 2018-01-02 MF Import

Date I -`? _7 Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address Pubhn WolkS Permit Bldg. Dept, s Public Works Fee Total Fee $ — Less APPI. Fee Pail $ Balance Due $ Phone Applicant Mailing Address City Zip Phone DesFribe Proposed Work 5, a_" in — Project Address (if known) be_ Attach four (4) copies of plans for proposed work - 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. 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 yogi dig. TOLL FREE NUMBER 1-800-424-5555. Approved for Construction Date FINAL INSPECTION Date Approved as Constructed i PUBV'WORKS DEPARTMENT Ever Cedar Street Everett, WA 98201 Phone: 259-8810 cZ 5.�2 Yv.s 0 l °`'° i� 03 / ACKNOWLEDGEMENT OF CONDITIONS W H Im O z O H O a 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. I 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 COMPLE110N. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.