1918 WALL ST 2018-01-02 MF Import

Datea___X 5 Application For PUBLIC WORKS PERMIT Print or Type Only Owner Mailing Address City Zip Public Works Pelmd e qFJ J — • O aldp. Dapt e Public Works Fee S Toter Fee Less AppL Fee Paid tt earance Due $ � c Applicant Mailing Address City Zip Phone Describe Proposed Work ( �7L < CA +\� -- W Project Address (if known) H Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: AIIIIIIIIIIIIIIIIII • 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 I. 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. z •kA-- `>l&�_k11-LC-3- 12 k�-Z17 Ti� CL�IIIC-� . "P�R��Ya�-�S �Cz I-R� `-c�'t'i.� C�LF�� • v� a Approved for Construction Date NAFI L INSPECTION Date Approved as Constructed E PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Rhone: 259.8815 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 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 prr. ,ierty damaged thereby. LP Signal r � pficanI Tft ry Date WORK AUT ORIZED BY RA11T 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.