8014 HAMLET LN 2016-01-01 MF Import

Date��-3 Application For PUBLIC WORKS PEFMIT Print or Type Only S�� S l Public Works Permit r 3 a sl eioe. oeni. • s Pu01'¢ Works Fee S 7/l. O a Tolel Fee Rd ' Lass AOOL Fea Paid : 9eiance Oue S ��• � � 337- 0660 ��M� Zip Phone Applicant Mailing Address City Describe Proposed Work �� Prolect Address (if known) Atfach four (4) copies of plans for proposed w�ork • Draw to scale and note the following as spplicable: � Pmperty Lines • Centerline ot street • Outline and dimensions of all ezisting and o indicate North propesed structures on the lot • Show any proposed grading changes • Exisling and proposed utilities • Show measurements PERMIT CONDITIONS 1. All celis 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 Cily of Everett Design and Construction Standerds and Specificetiona 3. Cell Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424•5555. /��i�p-��-� oved for Cons ruction ,/- Date -�i� - ��-y-��-� FI L I SPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259-d87 5 ACKNOWLEDGEMENT OF CONUITIONS W H � � � O � � O a The undersigned owner/app'.�cant hereby agrees to hold and save harm• less the City of Everett from any and all claims lor damages, costs, expenses, or causes of action thal may arise because ot inslallation and maintenance of lhe improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice trom the Cdy and to replace public property damaged thereby. � ,�Q_� Si ature ol Applicant Date WORK AUTHORIZED 6Y THIS PERMIT tv1UST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISBUED AND THEREAFTER IS TO BE DILIGENTLY PI�RSUED TO COD4PlETION. THIS PERMIT MAY BE CANCEILED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.