1402 SE EVERETT MALL WAY HICKORY FARMS 2018-01-02 MF Import

Date w Application For PUBLIC WORKS PERMIT Print or Type Only City Describe Proposed Work Public Woks Permit 0 n Bldg. DepL • Puollc Works Feo Talal Fee $ Less Appt Fes Paid S Balance Due- $ Project Address (if known) I Q OI�L " 1 1 Attach lour 14) 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 DO NOT WRITE BELOW THIS LINE OPERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. O ,r ` 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction 0 Standards and Specifications. C ►� 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. z 1111ift am, • s� iz -3 -90 V l i ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant 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 Approved for Construction Date City and to replace public property damaged thereby. FINAL INSPECTION Date _ Approved as Constructed Signature of Applicant Date PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN f. 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE everett Phone: 259.8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.