620 SE EVERETT MALL WAY BASE FILE 2018-01-01 MF Import

ia ti :� � � ' � �.a,� � � Date reC,�cP r1� Applicalion For PUBLIC WORKS PERMIT �� Print or'fype Only G nnamng naaress Describe Proposed Wor � � � Project Address Qf known) Attach four (4) copies of plans for proposed work • Draw lo scale and note lho following as applicabie: • Property Lines ! Outline and dimensions of all existing and proposed structures on the lot a Existing and propased utilities Public WorW Permil e �✓ Bltlp. DepL+ _ PubliG Work! Fee /� /£ <�� Tolal Fee : «� Le6a A00� Fea PelO S� Balenca Due S • Centerline of street • Indicate Norih • Show any proposed grading changes • Show measuremenls rnone PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. AII work shali be periormed in accordance with this permit and current City oF Everett Design and Construction Standards and Specificalions 3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. /i• �-�'"' GL�'�"!'�,.-�� S ;:.� FINAL INSPECTIONv Approved as Constructed � everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everetl, WA 98201 Phone:259•BB15 ACKNOWLEDGEMENT OF CONDITIONS W H � f� � O The undersigned owner/applicant hereby agrees to hold and save harm- less the City of EvereU from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance ot the improvement or other right-of•way use hereto applied for and further agrees to remove same upon notice Irom the City and to replace public property damaged thereby. /�� ///f�,Q�� - �Z--�' � Signatu�re of 1'yp��5n( T- 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 CANCt'�I.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJEC7 JVER 50 DAYS DURATION.