8013 HAMLET LN 2018-01-02 MF Import

!r -rt Date— Application For PUBLIC WORKS PERMIT Print or Type Only Public Works Permit a Bldg Dept. a Public Works Fee $ k.) V Total Fee Less AoPt Fee Paid $ Balance Due $ Ics e -er _1-I t-1 43r`Iau �!•�. OkF�. `iSS,;Q3 Cr,S9-�'R'-I1 Owner Mailing Address City Zip Phone !1 It Applicant Mailing Address City Zip Phone Describe Proposed Work Project Address (if known) ; o / 3 Attach four (4) copies of plans for proposed work - Draw to scale and note the following as. applicable: • Property Lines • Outlh a end dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PE9MIT CONDITIONS • Centerline ct street • Indicate Nerth • Show any proposed grading changes • Show measurements I 1. All call,, for inspection shall be made 24 hrs. in advance - phone 259.881 5. 2. All wotk shall be performed in accordance with this permit and current City of Everett Design and Construclion Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. _ y_ f FINAL IN. PECTION Date Approved as Constructed verett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS -i CA M O n 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 -tip replace public property damaged thereby. WORK AUTHORIZED BY THIS PERMIT M ST BE STARTED 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 DURATION. A