4815 S 4TH AVE 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only Z , Applicant Mailing Address City Zip Describe Proposed Work Public Woks Pe'.1 • [�� Bldg. Dept a Public Works Works Fee $ Total Fee Less Appl. Fee Paid $---�CJ�'T� Balance Due $ 2� Phone Phone Project Address (if known) - Attach lour 141 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 M DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance- phone 259.8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Underground s. 3. Call Location Underground Service 48 hrs. before you dig. TILL FREE NUMBER 1.800.424.5555. O N O a Approved for ConstruC on DaJ FINAL INSPECTION Date Approv, 'as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Everett, WA Street Everett, WA 98201 Phone: 259-881U ACKNOWLEDGEMENT OF CONDITIONS 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 cf the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to rep ce publl operty damaged thereby. 2G ignature of Applica Date WORK AUTHOR IZ BY THIS PER 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.