5416 S 1ST AVE 2018-01-02 MF Import

Date2 Application For PUBLIC WORKS PERMIT Print or Type Only Public Works Permit Bldg Deot. e Publ¢ Work, Fee Total Fee S Lea. APPL Fee Paid Balance Due i L rAppucam mating nearess ulty Zip Phone Project Address fit known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable, • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements 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 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 /n III/ ' ./✓�L"^�_�1� FINAL INSPECTION Date Approved as Constructed D PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everele tt, WA 98201 Phone259.6815 ACKNOWLEDGEMENT OF CONDITIONS M O n z O U) 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 applied for and further agrees to remove came upon notice from the City and to replace public property damaged thereby. d m( _ Signature of A lirat i Dat WORK AUTHO IZED' BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLET;ON. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.