1610 W MUKILTEO BLVD 2018-01-02 MF Import

Date Application For PUBLIC WORKS PERMIT Print or Type Only Owner Mailing Address City iA4 Applicant Mailing Address City Describe Proposed Work Project Address (if known) Zip Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable Bldg Dept. • 6 Public Works Fee $ Total Fee Less Pppl. Fee Paid S ^J� Balance Due $ • 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. 6 /is g Approved for 0onstr on I Date FINAL INSPECTION Date Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 evereh 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-ofrvay use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. ignature of Applicant Date WORK 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.