8415 E XAVIER WAY 2018-01-02 MF Import

Date 6 -1/P __y5 Application For PUBLIC WORKS PERMIT Print or Type Only PI,pLC Wode Permit • ��'^. � D / Bldg. Dept s PublicWorke Fee Total Fee Less APPI. Fee Pma S Balance Due S O`O 002- j?ZYo/3R3/ nkln�F /3It �i�,)—;Llf5�s?16.L'1�wQ OYIOP.I A^n�lr n.l AlidrYss l;lty ZID Phony Mailing 3- P" ,n, Describe Proposed Work��b__Q 'iarolect Address,(if known) Attach four (4) copies of plans tot Proposed work - Drava 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 PERMIT CONDITIONS 1. All calls for inspecti3n 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 Specifications. 3. Call Location Underground Service 48 h•s. before you dig. TOLL FREE NUMBER 1-800-424.5555. To 6'E DONG 14)i7-/1.N roar�day oi?LX. Lt-I"£. XAViF,-) fo Be c�d�oe wi �11 Bob c n 74 ��lur�i�teiTf — AA, frame ovT ey Si -vs 4. RM Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8810 H N 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 r 7 �s- and maintenance of the improvement or other right-of-way use hereto L applied for and further agrees to remove same upon notice from the / ale City and to replace public property damaged thereby. Date 6' 4' SignatuA 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.