9506 7TH AVE SE 2018-01-02 MF Import

Date 2 ho INI Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Mailing Address Public Works Permo + Dior, Dept + -7____ Public WOOSTee Total Fee Less APPI Fee Paid S Dalance Due $ City Zip Phone City Zip Describe Proposed Work .�_1)0101 b U A !nl4�_$ ! A Project Address lit known) _'Y7N Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • 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 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. • Approved for Date FINAL INSPECTION Date Approved Le as Constructed PUBLIC WORKS DEPARTMENT Ever Cedar Street Everett. WA 98207 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS C4 CM 0 z O O 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 ac!ion 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.