716 SE EVERETT MALL WAY MIDAS 2018-01-01 MF Import

Date � —3—b'8' Application For PUB�IC WC�RKS PERMIT Print or Type Only Address Applicant Describe Proposed Work Project Address (if known) Ci�Y Zip PuOlic Worka Parmil r Bldp. DePt. Y _��r� 9� PubliG Worka Fe0 Totel FaB $ Lese AOG� Fee Paltl Balante Due Attach four (4) copies of plans lor proposed work • Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicale North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements YhOOB PERMIT CONDITIONS 1. Alf calis for inspection shall tre made 24 hrs. in advance • phone 259•881 O. 2. All work shall be performed in accordance with ihis permit and current City oF Everett Design and Construction Standards and Specifications. 3. Call Location Undergro�nd Service 48 hrs. before you dig. TOLL FREE NUMBER 1-$00-QQ4•5555. /�l/�3G; c �aiz�.s �.s�...�.� .t/or .(�i-�,,v�,e,�a �-_> �, �; Approved for Construdion Dale FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everelt, WA 98201 Phone: 259�8810 a��s� ��, <� ; ' �'� � ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � 0 a The undersigned owne�/applicant hereby agrees to hold and save harm- less the City ol Everett irorr any and all claims for damages, costs, expenses, or causes of action Ihat may arise because of installation and maintenance of the improvement or other right•of�way use hereto applied for and furiher agrees to remuve same upon notice Irom ihe Ciry and to replace public property damaged thereby. Signature ol 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 PERM�T MAY BE CANCELLED BY THE CITY UPON ANY STGPPAGE OF WOFK ON THIS PROJECT OVER 90 DAYS DURATION.