8615 7TH AVE SE 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA g8201 (425) 257-8810 TYPE OR PRINT ONLY Date V — I & _C19 / Public Works Permit S 99 12(P3 Building Permit e Public Works Fee $ -- / iry-gdAlem Churc►n C615-76h Avc Srs.e�zr&Lt cjBW8 42-5-353-I-LI IF Owner %Mailing Address City Zip Phone $� 11 l mja rb 50x 15E� KOK; Z-75 qZ5 -35r, 7335eH 425.348.84—' Applicant Mailing Address City Zip Phone Describe Proposed Work >(1 t151OH1 W �IIIt• V / PROJECT ADDRESS (if known) -7�I Ave, 56 W Attach four (4) copies plans for proposed work - Draw fj scale and note the following if applicable: O • Property Lines • Outline 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 DO NOT WRITE BELOW THIS LINE Z PERMIT CONDITIONS: O 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 2. All work shall be performed in accordance with this permit and current City of Everett Design and ■ Construction Standards and Specifications. r 3. Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1-800-424-5555. ♦/\ pe(r approve P Ian dei� 1 i3 /C19 . O a Pam. wlG� � I131gg rove or.Conns ruc i Date FINAL INSPECTION Date Approved as Constructed ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless the City of Everelt 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 app!smor and further agrees to remove same upon notice from the City a ace public property dam- aged thereby. Signature of Applicanta e WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSl1E0 AND THEREAFTER IS TO BE DIUGENTL)' PURSUFDTO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.