6400 36TH AVE W 2018-01-02 MF Import

9D C,yC;0 HEM f4 A N H O OHta n 4]�C] H H In C]UCA E�Fa 0 CA Date_7a J47 EP Public Works Parml a �U / Bldg. Dept, a o Application For PUBIC WORKS PERMIT Public Works Fee Total Fes $ Less AppL Fee Paid pO Balance Due Print or Type Only 9 I a 9nSlf lD� r��e Owner �- cJ&ess city Zip Phone Oyy 33O_rfa VVOIL 0 Y! t Mailing Address City Zip Phone Describe Proposed Work Protect Address (if known) �.0'—t"v-� 3 �04 A.V� \�/- ��dG• ya•' .�C� 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 PERMIT CONDITIONS 1. All calls for Inspection 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, Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. 4 P,/ - c�Or^, e �� ixy_ Approved as Constructed i PUBLIC WORKS DEPARTMENT Ever Ceder Street Everett WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS 0 d Z Cn 0/� an 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. �;ynatLre 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.