3507 ROCKEFELLER AVE 2018-01-02 MF Import

DatEi_*so Application For PUBLIC WORKS PERMIT Print or Type Only JI.a l /d. iR157 q6l&&_ I A Owner Ll Mailing Add�ess City Mailing Project Address (it known) Zip Public Works Permits as Bldg, Dept • Im Public Works Fea Toral Fee $ Less Appt Fee Pa d $ Balance Due S 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 Phone 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. 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 Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOk�LEDGEMENT OF CONDITIONS M O z O The undersigned o.net, 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 City and to replace public property damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THI„ 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.