5048 33RD AVE W 2018-01-02 MF Import

DaIe�Q�� l Application For PUBLIC WORKS PERMIT Print or Type Only 12 Mailing Describe Proposed Work Protect Address (if known) Address _ '?-Z?;'u, Po 81dr, .or Public Works Fee Total Fee Less Aool. Fee Paid 5 % Balance Duo S I / 22 d83- 731 Zip Phone City Zip Phone Attach four 14) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • C-_:line and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • 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. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. Zz Z"'� CL, �� ,u z� y a 3�c/r�k1e2��u �iho�a"'� d �`:Zt� ��a aA 33•��",��veJ,�'�UG<l• o.�. �' ,UACKNOWLEDGEMENT ( OFC N ITIONS aai7' f3�' Approved for�ctio� Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Street Everett, l6 WA WA 98207 Phone: 259.8810 W O z O O am 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 bicause 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 Ci[tj/�nd to replacepublic property/damaged thereby. SI nature of Applicant r uate RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1 0 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.