405 SE EVERETT MALL WAY 2018-01-02 MF Import

DateS� 1 Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Describe Proposed Work Project Address (if known) Public Works Permit a V " Bldg. Dept s Public Works Fee $ 10� Total Fee Less APPL Fee Paid $ _ Balance Due $ �c�Oc9i— 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 PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. 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 UndergroundService48 hrs. before you dig. TOLL FREE INUMBER 1.800-424--5555. Approved for Coristruction7 Date r. FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS UJ I� O P Cn O am The undersigned owner/applicant hereby agrees to hoid 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. Signs ure of Applicant - Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP 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.