804 33RD ST 2018-01-02 MF Import

Ddted ?' c PUBLIC O O O S-0174 Ad Po3A'Ld1 010 Application For WORKS PERMIT Print or Type OnIE S r` o 0 ni cv a an uwnur 1 yr - i �D O 3 W O O 7 W ocex Applicant Describe Proposed Work Public Works Permit ✓< t �� / Bldg. Dept. a Pubhc Works Fee Total Fee $ Less Appi. Fee Paid $ Balance Due $ f°oy,33,rve•-Vr rE77 W,72 ,O,yo lg Address City Zip Phone t Mailing Address City Zip Phone XO If -ar Project Address (if known) 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. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. L-L Approved for CC000nnnssttrr on Date FINAL INSPECTION Date Approved as Constructed +everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS LU CIO Im O n 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 pl blic property damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE S RTED 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.