2101 62ND ST SE 2018-01-02 MF Import

Date Application For !.,UBLIC WORKS PERMIT Print or Type Only Applicnnt Describe Proposed Work Project Address tit known) 2/0/— Publ,c Work. Perms • Sp— CP Bldg Dept. Pubhe Works Fee total Fro Leo Ami Fee Poo S Balance Due 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 Phone PERMIT CONDITIONS 1. All calls for inspection shall be made 24 firs. in advance • phone 259.881 O. 2. All work shall be pedormee in accordance with this permit and current amity of Everett Design and Construction Standards and Specllications. 3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1.800-424.5555. �z9 n G a7-g9 Approved for :;Z/ Dele FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT Ever Street Everett.tt. WA WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS ■Uj n t� O q 'IME c/ O a The undersigned owner/applicant hereby agrees to hold and save harm less the City of Everett Irom 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. ti Signature of Applicant air 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.