3816 FEDERAL AVE 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only "D,A✓ Pubm. works Perms e dS �- .SS/ eis Dept . pf�/5�s0 7 Public Works Fee Totel Fee i Lose APpL Fee Pei i salaries Due t{ 2Ltd% yfao L owner Mailing Address City Zip Phone Applicant Mailing Address City Zip Phone Describe Proposed Work Project Address (if known) Attach four (4) Copies of plans for proposed work - Draw to scale and note the fallowing as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot - • Existing and proposed utilities PERMIT CONDITIONS • Centerline o' street • Indicate North • Show any proposed grading changes • Show measurements 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. 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 hire. before you dig. TOLL FREE NUMBER 1.800-424.5555. ACKNOWLEDGEMENT OF CONDITIONS W N W O M2 z O O m lF% The undersigned owner/applicant hereby agrees to hold and save harm- less the Ctry 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 fond further agrees to remove same upon notice from the Approved for Constructio%. ate ° City and j6/feplace public property damaged therehy. Approved as Constructed r6jPJBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 FA S' nature of Applicant Date ORK AUTHORIZED BY THIS PERMIT MUST BE SfARrED 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.