11110 7TH AVE SE 2018-01-02 MF Import

Date. 11—rr- L < ( Public Works Permit • I ,' Application For Bldg Dent PUBLIC WORKS PERMIT PuElicwgrxs Fee Total Fva S Less Appl. Fee Paid $ Print or Type Only Balance Due S 1ur- �.P/9 5�? �� nglab Papa Owner Mailing Address City Zip Phone lira�IOG -//''A /� Applicant Mailing Address City Zip Phone Describe Proposed Work Project Address lit known) Attach four (4) copies of plans lot proposed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed ^tructures on the lot • Existing a i 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 firs. 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 firs. before you dig. TOLL FREE NUMBER 1-800-424.5555. PW Z/nc &)Or4s Armif /vvf R(Nu;reo/ `h& L l 6roo kS Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 1 Phone: 2F9.8810 ACKNOWLEDGEMENT OF CONDITIONS 03 O z O O a 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. Signature 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.