1402 SE EVERETT MALL WAY EVERETT MALL EXPANSION 1987 SHELL 2018-01-02 MF Import

DateLEZ:�7 Application For PUBLIC WORKS PERMIT Print of Type Only City Public Works Permit a elaa Door. Public Works Fee Total Fee $ Lass APPL Fee Paid Balance Due Applicant Mailing Address City Zip Phone Describe Proposed Work W �. Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following a pplicable: • 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 • Snow measurements DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. 2. All work shall be performed in accordance with this and City 0 permit current of Everett Design and Construction Standards and Specifications. 3. Call Location Under3round Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424-5555. z PG�L i L Lvo�.eS PEe/�/T �.f�T�EgUr•E'c�C� �38 7 J Cl) 0 am Approved for Construction Date as Constructed ' evere(t PUBLIC WORKS DEPARTMENT vCedar Street Everett, WA 98201 Phone: 259.8815 Date ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agree:: to hold and save harm- less the City of Everett from any and all clains for damages, costs, expenses, or causes of action that may arise Tecause of installation and maintenance of the improvement or other rght-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged theraby. Signature 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.