2430 GRAND AVE 2018-01-02 MF Import

Dateat2j�019 mo Application For PUBLIC WORKS PERMIT Print or Type Only k'L K Public Works Perryey�,��,�y� 81P0. DePL + iIJ�JC`--'q�ri I� Public Works Fee $ Total Fee Less Appl Fee Paid S Balance Duo S Applicant Mailing Address City Zip Phone Describe Proposed Work Project Address of known) - Attach four (4) copies of pla.ib for proposed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection 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. Approved for Construction FINAL INSPECTION Approved ar Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett. WA 98201 Phone: 259-8810 Date 5- Z?_ 80t ACKNOWLEDGEMENT OF CONDITIONS W H Ch M O M) z O I- O a The undersigned owner/applicant hereby agrees to hold 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 •ise 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 STARTS' WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 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 DUPATION.