1402 SE EVERETT MALL WAY CINEMA I II III 2018-01-02 MF Import

Date k ul fl If_"S' eo► Application For PUBLIC WORKS PERMIT Print or Type Only Pub )I ic Works Per Bldg.ml aloe. Dear., L Public Works Fee $ l aral Fee Less Appt Fee Paid S Balance Due S" Owner Mailing Address City Zip Phone Applicant Mailing Address y� {� City Zip Phone DescW a Proposed Work W Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following a icable: r_ • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North V+ proposed structures on the lot • Show any pioposed grading changes • Existing and ,proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. s* 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction i Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. VVFF a Approved for Construction Date FINAL INSPECTION Approved as Constructed 11) PUBLIC WORKS DEf ARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 269.8810 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and Lave 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 City and to replace public property damaged thereby. Signature of Applicant uate WORK AUTHORIZED BY THIS PERMI'r MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO I 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.