309 MORGAN RD 2018-01-02 MF Import

Date la -3 Application For PUBLIC WORKS PERMIT Print or Type Only ng Describe Proposed Work 1"i X< N ty Public Works Perm Bldg. Boot 3 �z Public Works Fee 4 Total Fee Less APPr Fee Paid S Balance Due $ Project Address (if known) d rk - Draw to scale and note the following as applicable: Attach tour (4) copies of plans for proposewo • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities 0110111 —DO NOT WRITE BELOW THIS LINE • Centerline ot,treat • Indicate N •rth • Show any proposed grading changes • Show measurements Phone PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs, in advance - phone 259.8815. e with this permit and current City of E. ADesign and Construction 2. All work shall be performed in accordanc Standards and Specifications. ice 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424-555 5. 3. Call Location Underground Se" Approved for Construction LL I- oz O Irk-y 1 VL4010: �� t,r Pe �f_ � o a 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 instahation and maintenance of the improvement or other fight -of -way use Date applCity lend to eplace publ cgpropertyrdamaged herebyn notice from the Date FINAL INSPECTION Approved as Constructed PUBLIC WORKS DEPARTMENT L61 Cedar Street Evere3200 tt, WA 98201 Phone: 259.8815 L Dale ?S'nature of Applicant AUThORIZED 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.