1402 SE EVERETT MALL WAY GORDON JEWELERS 2018-01-02 MF Import

Date-4— Application For PUBLIC WORKS PERMIT Print or Type Only rJ tErtXX-►-` W1 Address r PvorP work: P�mil Bldg Dept* r Public Works Fee $ Total Fee Less APPI. Fee Paid $ Balance Due Phone City ZIP Phone Applicant Mailing Address Describe Proposed Work _T�'� ��vu � �' � " �"'LE—kfl- - Project Address (if known) Attach four (4) copies of plans for propo, ed work • Draw to scale and note the following as applicable. • Property Lines • Outline and dimensions of all existing and • Centerline of street • 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 stall be made 24 hr: in advance - phone 259.881 5. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Constr•- :lion Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. np pod iG W 14s 05'rnl u' rnv Approved for Construction Date FINAL INSPECTION Date Approved as Constructed W PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS z 0 00 The undersigned owner/applicant hereby agrees to hold and save ha- m- 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 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.