1911 W MUKILTEO BLVD 2018-01-02 MF Import

• 7o O � fog Date /9 S Cf/e�r.✓G i_ ; i Application For PUBLIC WORKS PERMIT Print or Type Only City E` City Describe Proposed Work Project Address (if known) Public Works Permit a G6--116 Bldg. Dept. e E5Z17 / 3S Public Works Fee Total Fee $ Less Appl. Fee Paid $ Balance Due $ 7 gS7 if ci S - P •/ Zip Phone Zip Phone Attach four (4) -opies 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 firs. in advance • phone 259.881 5. 2. All work shell 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. n Iq Approved for C nstruction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT Ever Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOWLEDGEMENT OF CONDITIONS W H z O 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 other right-of-way use hereto appliedfor and furthgrees to remove same upon notice from the City n to replace b c property damaged thereby. ature of Applicant Date Ie YfORK 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.