6531 OLYMPIC DR 2018-01-02 MF Import

Date411-1/$4 Application For PUBLIC WORKS PERMIT Print or Type Only A M Q' Applicant t _ 1,r A r- ailing Address Mailing Address Public Works Permit • /'16 Bldg Dept / eylO_sJ PubM1c Works Fee 1 01Rl Fee S Less Appl. Fee P.,d S Balance Due S :ML 9k21`13g4- 337- /(&sy City Zip Phone Zm Describe Proposed Work ZPW—Qt4Lzt L4Tf � R&C& 10 aVe'--IV hIl /(_t .A y z - 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 • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Shaw any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O 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. 0 0 a Approved to Construction Date .2-,LG - iJ FINAL INSPECTION Date Approved as Constructed i PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201920i 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 *KAU lace publi properiv tlamagetl thepplica RIZED By THIS PERMIT MUST RE STARTED v;"THIN 180 DAYS OF DATE PERMIT IS ISSUEC AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. TH;S PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.