5702 EAST DR 2018-01-02 MF Import

ter Application For PUBLIC WORKS PERMIT Print or Type Only Uw, 7-475 Public Works Permil • , Bldg Dept Public Works Fee Fee Total$ Less APPL Fee Paid $� V Balanoo Due _20 i '111 ZZip Phone Applicant Maliing Address City Describe Proposed Work S J Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note Centerline of sVeeit,;able: • Property Lines • Indicate North • Outline and dimensions of all existing and • Show any proposea grading eianges proposed structures on the lot • Show measurements • Existing and proposed utilities PERMIT CONDITIONS 1. All calls for inspection shall be made 24 his. 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 hrs. before you dig. TOLL FREE NUMBER 1.800.424.555 . Approved as Constructed i PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8615 U) O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned ownenapplicant 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 ASignattir areblic property damaged thereby. of Applicant Date WORKUTHORIZED BY THIS PERMIT MUST BE S1 IRTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED OTHEREAFTER BE DIILIGEI TLYPURSU D TOCOMPLETTION.THISPERMIT MAY E CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.