2320 63RD ST SE 2018-01-02 MF Import

DatetS i Application For PUBLIC WORKS PERMIT Print or Type Orly sr 1,✓�., L. LAit4(F -,-Amf Applicant Mailing Address Describe Proposed Work Public Wuxi Pamir • Bbg Dart Pubr,c Worb Fsa Total Fee $ — L 1 APDL Fea Pe1C Balance Due $ zip Phone rroject Address (it known) f+�2 ,� �1 ��:=T L., � 6 J�,4 Attach four (4) copies of plans for proposed work - Draw to ncm3 and note the following as applicable: • Property Lines • Centerfine of street / w • Outline and dimensions of all existing and • Indicate North V, proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT Will] E BELOW THIS LINE PERMIT CONDITIONS O 1. All calls for Inspection shall be m:.de 24 firs. In advance • phone 259.8815. 0 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. z Appr ed t�tru�-� ® _ � i Dote Approved as Constructed evrrer PUBLIC WORKS DEPARTMENT Ever Cedar Street Everett, WA 98201 Phone: 259.8815 0 a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to field and save harm. less the City :f Everett 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 applied for and further agrees to remove same upon notice from the City and to replace pub prop y damaged thereby. Signature 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.