4311 OLYMPIC BLVD 2018-01-02 MF Import

Date --6?Z— Application For PUBLIC WORKS PERMIT Print or Type Only TO P"'Till f,_ s> 93— Applicant Mailing Address City ��yyQ) Public Works Permit • a�O Bldg Dept. • :: / 59 Public Wdrke Fee $ Total Fee Leas Appt Fee Paid 5 _ Balance Due a.-{ Describe Proposed Work - W 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 CIO 0 Show any proposed grading changes proposed structures on the lot • Existing and proposed utilities Show measurements M W DO NOT WRITE BELOW THIS LINE 0 ' 1 PERMIT CONDITIONS be made 24 hrs. in advance -phone 259.8810. W4 ' ' U 1. All calls for inspection shall 2. All wo.. 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. z 0 1 Cl) sisal a �—as 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, or causes of action that may arise because of installation —� expenses, /' and maintenance of the improvement or other right-of-way use hereto `�" further across to remove same upon notice from the y Date applied for and City and to repla a ublic properfv damaged thereby. Ap oved for Constructioh FINAL INSPECTION Date Date Sig nature of A licanl Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN PERMIT IS ISSUED AND THEREAFTER IS TO PUBLICWORKS DEPARTMENT 180 DAYS OF DATE BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE 3200 Cedar Street Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone: 259.8810 PROJECT OVER 90 DAYS DURATION.