4434 SEAHURST AVE 2018-01-02 MF Import

N Dale Public Work, P mil 40 �'.�_� Bldg. Dept. , Application For PUBLIC WORKS PERMIT Print or Type Only Ask O 1irl J g L J `l Owner Malling Address 11 Address Describe Proposed Work 1,3 Project Address tit known) City Public Work, Fee $ Tolel Fee Less APPL Fee Field $ Balanco Due $ Attach four (4) copies of plans for proposed work - Draw to scale and note Centerline as of applicable: • Property Lines • Indicate North • Outline and dimensions of all existing and • Show any proposed grading changes proposed structures the lot • Show measurements • Existing and proposedd utilities - y.srl PERMIT CONDITIONS 1. All calls fur inspection shall be made 24 hrs. in advance - phone 259.881 5. 2. F.1 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 yru dig. TOLL FREE NUMBER 1.800.424.5555. Approved for Construction Date FINAL INSPECTION Dale Approved as Constructed i PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everele tt, WA 98201 Phone: 259-8815 3 ACKNOWLEDGEMENT OF CONDITIONS W H N ca 0 M) H Cl) 0 a The undersigned owner/applicant hereby agrees to hold and save harm, labs 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 of 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. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT 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.