4626 GREELY ST 2018-01-02 MF Import

Date# 7' - Application For PUBLIC WORKS PERMIT Print or Type Only 416 zoo c Mailing Address Public Works Permit • 7 Soy Bldg. Dept 0 Public Works Fee S coral Fee Less Appi Fee Paid Balance Due $ -20 City Zip Phone _ S1 yY� /r ' Wes. Applicant Mailing Address City Zip Phone Describe Proposed Work i Ao-.n le O Project Address (if known) C. a Pr 1i n. S. c '�b ;A1 1,4 elC- Attach four (4) copies of plans 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 PERMIT CONDITIONS • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. 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. T /.P FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 S c c-T�0 / I � ACKNOWLEDGEMENT OF CONDITIONS z O 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 use hereto applied for and further agrees to remove same upon notice from the City and to replace public properly dam thereby.. / ignature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF'TEP IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOF K ON THIS PROJECT OVER 90 DAYS DURATION.