4724 SEAHURST AVE 2018-01-02 MF Import

— 03 & /� Date // 7 Public Works Permit • ] . Application For emq. Dept.. PUBLIC WORKS PERMIT Pebhc Work. Fee $ Total Fee Less Appl. Fee Paid $ Due $✓�) "l,y'`�� Balance Print or Type Only Owner Mailing Address '� City Zip Phone Applicant Mailing Address City Zip Phone Describe Proposed Work W _ Address known) % Z SG f�L%.t'ST ni ✓t_- Project (if _ Attach four (4) 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 259-881 5. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specih.at ions. 3. Call Location U:tdergro Ind Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. ' Approved f r Const�ru on Date FINAL-4<AKTION Date Approved as Constructed i PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, 'JJA 98201 Phone: 259.8815 O a 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 property damaged thereby. S'""ig��nature of Applicant Date Tvv-1K AUTHORIZFD BYL HIS PERMIT MUST BE STARTED WITHIN 80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TC COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DANS DURATION.