2931 NASSAU ST 2018-01-02 MF Import

Date y �B Application For PUBLIC WORKS PERMIT Public Works Permits Burp DPPL s Publ c Works Fee $ Total Fee Less APPI. Fee Paid $ Print or Type Only Balance Due $ -rim ql�w1 5j�33a Owner Mailing Address City Zip Phone LindAc_,, m l-if'l n6 d -),q; l /UG55au C 'erg qS2__"y Describe Proposed Project Address (if known) Mailing Address Fron�l 29d /— 4/4 SS•L L+ City Zip 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 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 Gonstructicn i/ /Date FINAL INSPECTION Date Approved as Constructed everetl PU13LIC WORKS DEPARTMENT Ever Cedar Street Everett, WA 98201 Phone 259.3810 ACKNOWLEDGEMENT OF CONDITIONS LU O� z O O a The undersigned owner/applicant hereby agrees to hued 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 mainte nce of the improvement or other tight-ol-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public properly damaged thereby. Signature of Applicant att WORK AUTHORIZED BV91S PERMIT MUST BE STARTED WITHIN 180 D.YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DI, (GENTLY PURSUED 70 COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.