1706 63RD ST SE 2018-01-02 MF Import

Date Application For PUBLIC WORKS PERMIT Print or Type Only Describe Proposes Work Project Address (if known) 3 /Iv Nblu: Welke P""t @9 / Bldg oePL e Pubs¢ Wmb Fee S TWO Fee Fee Len appr Fee Pald S Balance Due S '� uny d note the following as applicable: Attach tour 141 copies of plans for proposed wo• Centerline of Streetrk -Draw to scale on • Property Linea • Indicate North • Outline and dimensions of all existing and Show any proposed grading changes proposed structures on the lot 9 Show measurements • Existing and proposed utilities LOW THIS LINE PERMIT CONDITIONS hone 259-8815. shell be made 24 in advance - p accordance wllh this pP•,nit end current City of 2. All work shell be performed in Everett Design end Construction 1. All calls for Inspection Standards and Specifications. TOLL FREE NUMBER w 3. Call Location Underground Service 48 hrs. before you dig. .ws t � �e. ♦/ _ pp.r Nr, L I r OA FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett. WA 98201 Phone: 259.81315 N ZI/all -69S W Iwo Imm CD on 0 z 0 Cn 0�q Ai ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/8PPlicant hereby agrees to hold and save arm- less the City of Everett from any end all claims for damages coals, ay arise ecause of aeApenses. or causes of action nd maintenance of the Improvement or or other rblght of•Way useahereto appled for and further rees to Cityland to replace Public propertyrdamaged thereby.emove same uponotice Iron the �i., cliU/mil 7 �S�' Date Signatu of Applicant 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 BYTHE CITY ONANY STOPPAIE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.