305 SE EVERETT MALL WAY ADVANCE CHECKING 2018-01-02 MF Import

r Aoplicatior For PUBLIC WORKS PERMIT Public Worxs Perrt *9-135� Bldg. D•PL Public Worl,s Fee S Tole) Fee _ Less APPI Fee Pdel S Print or Type Only Bopnce Dun Al dviftme. Au%'oa_ Owner Mach j Address City Zip Phone Applicant Mailing Address City Zip Phone DesOnL. Proposed Work Protect Address (if known) Attach four t4) copies of plans for proposed work - Draw to scale and note the following as • Property Lines • Outline and dimensions of all existing and proposed structures on the Int • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection shill be made 24 hrs. in advance - phone 259.8810. 2. All 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 dig. TOLL FREE NUMBER 1 .800-424.5555. 11n� Irari Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett. WA 98201 Phone: 259-8810 ACKNOWLEDGEMENT OF CONDITIONS Im O n z O M 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 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.