1205 SE EVERETT MALL WAY BASE FILE 2018-01-02 MF Import

Date Application For PUBLIC WORDS PERMIT Print or Type Only Owner >-_�?= Address Public Works Permit * sldq. Dept. R Public Works Fee Total Fee $ Less APPt Fee Paid S Balance Due $ 3_T o0 5 527-208.S Phone SF✓me- Applicant Mailing Address City Zip Phone Describe Proposed Work —rT.P✓CT �E'Ti9i� 9.�3�// I�UiL11/it/Cr Ar Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable • Property Lines • Centerline of street • 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 PERMIT CONDITIONS 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 hrs. before you dig. TOLL FREE NUMBER 1 -800.424.5555. $� S/TE`�JO�C TO BE 1>Oir/� PE�2 F�/�.oeovFD Im d q ♦♦ � ChA O a 06/20/U 4:45PM OOOAH0625 Ur* ACKNOWLEDG 415 & CONDITIONS The undersigned owner/applic et ag;ag�08hold and save harm- less the City of Everett from Q, nd all$MgWfor 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 /•art• applied for and further agrees to remove same upon notice from the Approved forCoristruVion ' Date Ci a d to replace pub roperty damaged thereby. l l6167 ao FINAL INSPECTION Dale Approved as Constructed Signature ppl cant Date everett PUBLIC WORKS DEPARTMENT WORK A ORIZED BY THIS RMIT MUST BE STARTED WITHIN 3200 Cedar Street BE DAYS DATE PERMIT IS ISSUED AND THEREAFTER IS TO tDILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Everett, WA 98201 BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone259-8820 PROJECT OVER 90 DAYS DURATION.