8011 HAMLET LN 2018-01-02 MF Import

r IN r Date Al. z-8-y Application For PUBLIC WORKS PERMIT Print or Type Only Mailing � S_ Q r PUbl,c Works Permit • Bldg. coot. • /3/7Y Public Works Fec s �, UG Total Fec Less APpi Fee Pelf S Balance Due $ ,6 ai P OW98aoy Zip Phone Zip Phone Describe Proposed Work - W _ o 7,c Zn. f 33 LU Project Address (if known) 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 • Centerline of street • Indicate North proposed structures on the lot • Existing and proposed utilities • Show any proposed grading changes • Show measurements M DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 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. O O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, causes of action that may arise because of installation ✓ expenses, or use hereto appliemaintenance ff of the improvement or v other right-of-way notice /applied for nd further agrees to remove same upon notice from the pprovr:d r n tructlon Date City and to�place public property damaged thereby. 1 3 /� FINAL INSPECTION D to Approved as Constructed ' ill Date Signature of Appli a WORK AUTHORIZED BY THIS PERMIT MUST BE TARTED WITHIN everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND T EREAFTER IS TO PERMIT MAY BE 3200 Cedar Street Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THI CANCELLED BY THE CITY UPON ANY STOPPAGE -OF WORK ON THIS Phone: 259.8815 PROJECT OVER 90 DAYS DURATION.