607 65TH PL SE 2018-01-02 MF Import

Data Application For PUBLIC WORKS PERMIT Print or Type Only Describe Frcposed Work Project Address (if known) 675 ;t4 Public Worb Permit • Bldg Debt • � — Public W,,%, Fee j Tool Fee Less xePi Fee Pud Btlence Due i— Attach four (e) copies of plane for proposed work • Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of ell existing and • Indicate North Proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calla for Inspection shall be made 24 hrs. In advance • phone 259.8815. 2. A:I 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. TOIL FREE NUMBER 1.800.424.5555. 5. _►1t�.p �la,«�. Approved for Construct) n ate FINAL INS P.G Date Approved as Constructed eterett PUBLIC WORKS DEPARTMENT 3200 Coder Street Everett, WA 982018201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS z 0 ♦♦Fr V/ 0 a The undersigned owner/applicant hereby agrees to hold and save harm. leas the City of 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 public property damaged thereby. AJ �— /J ,21 -,r / Slgn*re of Applic ` I Date WORK AUTHORIZE6 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.