4712 S 3RD AVE 2018-01-02 MF Import

Date�L y Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Describe Proposed Work Project Address (if known) Address 1 Zip Zip Attach four (4) cootes of plans for proposed work - Draw to scale and note the following as applicable l' WOrM6 Per It Bldg Dept e Puefc WO to Fee S 7A l7 0 Tohl Fee Less Appt Fee Paid S ealenca Due S —ci c3 rl • 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 its Show measurements (a-s 0 79 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 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. 7 -f 'App'roved for Construction Dale FINALINSPECTION ate Approved as Constructed W PUBLIC WORKS DEPARTMENT Ever Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOWLEDGEMENT OF CONDITIONS ON Fm (A) O am The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims (or damages costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-ol-way use hereto applied for and further agrees It, remove same upon notice from the City and to replace publ" pro rty damaged thereby. Signature of ppticant Date WORK AUTHORIZED BY THIS PE IT 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. Cr7