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

Application For PUBLIC WORKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 259-8810 TYPE OR PRINT ONLY 6b t3 ' Date C Public Works Permit # S Building Permit N Public Works Fee S Ml i Mailing Address �� City Zip Phone nJ�rQ-�T� lz8l� ��E3� ?aM. Describe Proposed Work VWE-N4-f t-�, �AO"\ .� �Jv�nJ wil ki� eWr, M&A4QJ;hC.tN-.r- 2A++�tP taec4 s�44vL 'r�kC, l,�ct�S . •� PROJECT ADDRESS (if known) ,Ct' Y mL► Attach four (4) copies of plans for proposed work - Draw to scale and note the following if 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: DO NOT WRITE BELOW THIS LINE 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and O Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. LL 12/%/95 9 29RM 000A#341 ff00095528 OTHER q n,r,.-111�6 CHECK $20.00 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation a„� 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. r ignature 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 COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.