801 LAUREL DR 2018-01-02 MF Import

Date Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Public Woks Pelmil . Bldg. Dept. Public Wolks Fee Total Fee $ — Less AppL Fee Paid $ Balance Due $ _ Zo\ Phone City Zip Phone Desc(('rri�ibe Proposed Work of �1 %� A'r 11rel-x' Y +'b 101 19 lay, k Project Address (if known) 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 inspectiun shall 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. 1G% Approved for Construction FINAL INSPECTION Apprm ad as Constructed I rett PUBLIC WORKS DEPARTMENT Ever Cedar Street Everel4 WA 98201 Phone: 259-8810 Date Date lam' ACKNOWLEDGEMENT OF CO 41TIO W /mow' z 0 0 a The undersigned owner/applicant hereby agrbe t of arS skive harm- less the City of Everett from any and all clai star dam gas, costs, expenses, or causes of action that may arise eca se of installation and maintenance of the improvement or olhe `rig vof-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 18o DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER. IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANYSTOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.