4817 OCEAN AVE 2018-01-02 MF Import

DateJe�.�-� Application For PUBLIC WORKS PERMIT Print or Type Only Public works Permit Bldg Dept. Public Works Fee S Total Fee Less Appt Fee Paid $ Balance Due c R-u i '.%c�5/7 r1LjfUkt �lf/�yP�P.flj- t%PZC3 �C,�.PS Ulj Zip Phone Ot. per Mading Addre.,_ Phone Mailing Describe ProFosed Work 1) (_�— Q Project Address (if known) LfRI7 DC^ H, Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Centerline of street • Property Lines • Outline and dimensions of all existing and • Indicate North Show any proposed grading changes proposed structures on the lot • Show measurements M • Existing and proposed utilities W DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 O. 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 1.800-424-555 O a Approved for Construction Date FINAL INSPECTION Date Approved as Constructer) W PUBLIC WORKS DEPARTMENT 3200 Cedar Street EverEverett, WA 98201 Phone, 259.8810 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. 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 damaged thereby. to Signature of Applicant IN 180 DAYS AUTHORIZEDWORK PERMIT By THIS BSTARTED OF DATEPERMIT ISISSUED ANDTHEREAFTER ISTO 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.