21 SE EVERETT MALL WAY CITY RADIATOR 2018-01-02 MF Import

Date * ' Application For PUBLIC WORKS PERMIT",i �_,( Z �1 Print or Type Only 1u Punic Works P_e-�rinull �3��'-'--C BldgDopl- Public --- Works Fee �j— Total Fie S Less APPI. Fee Paid S Balance Due Phone Applicant mating ADaress City Zip Phone UJ Project Address (if known) 2 i S. FdF�P.E7l /97ALC Gc./.9d_ 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 DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS O 1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. 2. At: 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 -:ig. TOLL FREE NUMBER 1-800-424.5555. i O O a 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 br and rher agrees to remove same upon notice from the App/r" r Co/} flru on Date City and to re public properI damaged thereby. FINAL FINAL INSP�ION�G Approved as Constructed Signature of Applica Date W PUBLIC WORKS DEPARTMENT WORK AUTHORIZEDAED IS PERMIT MUST BE STARTED WITHIN 3200 Cedar Street 180 DAYS OF DATEIT IS ISSUED AND THEREAFTER IS TO Everett, WA 98201 RE DILIGENTLY PURTO COMPLETION. THIS PERMIT MAY BE Phone: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.