1918 WALL ST 2018-01-02 MF Import

Datel'd �Y' ApplicaPon For PUBLIC WORKS PERMIT Print or Type Only Public works Permits Bldg. Dept. s Public Works Fee Total Fee $ _ Less APPL Fee Paid S ^ _ Balance Due s 12e, (.'Q .PEC. # 7ZS�9B �/ '41 ��'7✓ ?aeo e'o�.rEt z�.� io! � 'eFYaWC 2!i Owner Mailing Address City Zip Phone Ague iz7-6 A:- ML/l_ ,4 937-0G_ Applicant Mailing Address City Zip Phone Describe / !. ' v iief d%Z<& I a ' /., i i i a A /.s// cqrrr0> Attach four (4 r propose wor. • Properly Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS -ry the following as applicable: • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements 1. All calls for inspection shall be made 24 his, 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 Undergr,-ind Service 48 firs. before you dig. TOLL FREE NUMBER 1 .800.424.5555. i� .�ESrp/'E STG'E_ �T Sv2f oCE Tv 0-12e-""4a L AS �F%c'. /TJ/ C%/C co4l.-3o,7— Approved for Con{st`uc_tion /b,le 1GAL I1��i Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOWLEDGEMENT OF CONDITIONS z O 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 same upon notice from the City and to replace public property damaged thereby. Signatutpfppplicant — U Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PI IRSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.