8019 HAMLET LN 2018-01-02 MF Import

r Date � Application For PUBLIC WORKS PERMIT Print or Type Only Pudic Works Permit a Blaq. Dept. • ¢-- Public Works Fee $ Total Fee Less Appr Fee Paid s Ill Balance Due $ $ C) Ci A Zip PhonF. Applicant Mailing Address City Describe Proposed Work 4 A Z Project Address (if known) �� h' �� -� Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements 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. for FINAL INSFWIIUN l Approved as Constructed v ii PUBLIC WORKS DEPARTMENT 3200 Cedar Street EverEverett, WA 98201 Phone: 259-8815 L Date Date ACKNOWLEDGEMENT OF CONDITIONS W CA Im 0 z 0 0 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 appIted f r a o further agrees to remove same upon notice from the City a - o r plac: public property damaged thereby. ;ISTO Signature of Applica ' WORK AUTHORIZED BY THIS PERMIT MUST BE TARTED 180 DAYS OF DATE PERMIT IS ISSUED AN EREAFTE 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. ..II