6525 OLYMPIC DR 2018-01-02 MF Import

Date' GCI Application L&I PUBLIC WOR PERMIT Print or Type Only g p�gpo Re N M M r. Owner Mailing Odix tyz�� u as Mailing Address Describe Proposed Work 1, [-'a--, �)LI)e'vL __ Project Address fit known) t/ Public Works Perid,lf' '4ZZ BIOS Dept a � Public Works Fee Total Fee $ Less Appl. Fee PaN $ Balance Due $ Zip Phone Cod AZT %L�'M �=lL. Dt? 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 LI PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. 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. Approved for Cnn `•lion Date FINAL INSPECTION Date Approved as Constructed everelt PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS n 7 U) Im O n z O U) 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 o!her right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. FSignahfre`of Apo cdnt - " Date WORK AUTfi IZED BY THIS PERMIT MUST 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.