1701 63RD ST SE 2018-01-02 MF Import

Application For PUBLIC WORKS PENMIT Print or Type Only Publw Work, Permit e 96 - 351V 9100Deft • e9 Pubbt WOlke i N Tolelfee � Lett Apo' Fee Pas! Balance Dee Applicant 11 Mailing -Address City Zip Phone Describe Proposed Work i Project Address (if known) �70��d —=� ��d s7f S E _ W Attach lour (4) copies of plans for proposed work •Draw to scale and note the following as applicable: • Property Lines • Centerline of street / w • Outline ,nd dimensions of all existing and • Indicate North V, proosed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE PLPMIT CONDITIONS 1 All calls for Inspection shall be made 24 hrsin advance • phone 259.8815. 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. z I�usr��t dey�s -r0mie .ems ;rap Approved for Cons) o -I)a(e— FINAL INSPECTION Date Approved as Constructed D PUBLIC WORKS DEPARTMENT 3200 Everett, WA 9 reet 201 Everett, WA 98201 Phone: 259.8815 O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and nave harm• leas the City of Everett from any and all claims for damages, costs, expenses, of causes of achan 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 �toreplace public property d/�ged thereby. j Signature of Applicant Dale 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.