909 SE EVERETT MALL WAY BENEFICIAL FINANCE 2016-01-01 MF Import

Date /�� 6 / � / Apolication For PUBLIC VWORKS PE�MIT Print or Type Only Address Describe Proposed Work Gny up ProjectAddress�ifknown) (J��-� `�� VJ='�1"�l "IM1� Attach tour (4) copies of plens for proposed work • Draw to scale and note the fol�owing as • Property Lines • O� �'�ne and dimensions of all existing and proG�sed stmctures on the lot • Ex!sting and proGosed utilities - Pu011e Workn Permp r / [� 6IE9.OeGt r /r�/ /T �•/ � � Pu01it Works Fee s iolel Fee - Less Apo� Fee PaiO S Calance Due Zlp raone • Centerline of street • Indicate Ncrlh • Show any proposed grading change� • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall 6e made 24 hrs in advance • phone 259•881 5. 2. All work shall be performed in accordance with this permit and currem City of Everett Design and Construction Standarils ar.d Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•B00•424-5555. �(/�'J /�U.�G�G Cc1o�s �E,��iT �EL�U�,eEO // /7-$6 C=�F� for Construction INSPECTION ad as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 92201 Phone:259-8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O The undersigned owner/applicant hereby agrees to hold antl save harm- less the City of Everett from any and all claims for damages, costs, expenses, or causes ot action that may arisa because of installation and maintenance of the improvement or other righFof-way use heielo applied for and further agrees to remove same upon nofice irom the Date City and to replace public property dama9ed there6y. ua�e Signature ol Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS i0 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF' WORK ON THIS PRCJECT O'vER 90 DAYS DURATION.