5406 EAST DR 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Describe Proposed Work Project Address lit known) Mailing Address q I�J Public Works Permit •� 1 _ Bldg. Dept. •/ Public Works Fee Total Fee $ Le$$ April. Fee Pero $ �^ Balonce Due $ City Zip Phone Attach four (4) copies of plans for proposed work - Draw to scale and note the foliuwing 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 DO NOT WRITE BELOW THIS LINE 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 his. before you dig. TOLL FREE NUMBER 1-800.424-5555. 4. OCT Approved for Construction Date c FINAL INSPECTION Date Approved as Constructed evere0 PUBLIC WORKS DEPARTMENT Ever tt,WACedaStreet Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from an, 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. ' v Signatur of Applicant Date WORK AUTHORIZED BY TH 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 DAYS DURATION.