403 72ND ST SE 2018-01-02 MF Import

Date_sx Application For PUBLIC WORKS PERMIT Print or Type Only Owner 11 Mailing Address City Zip PurO¢ Woks Par e s I Y' 1/ e10e Deer e PubIK Woks Fee Total Pee S Less A001 Fee Pea S aslence Due Phone Describe Proposed Work r—JpC L--t"-J I in E Project Address fit known) 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 PERMIT CONDITIONS 1. All calls for Inspection shell be made 24 hm in advance • phone 259.8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specification& 33..JCaallll Location Underground Service 48 bra. before you dig. TOLL rFREE NUMBER � 1.800.424.5555. //0TO A� con. Ce'6'0.1-u�r� ?gelo2ea drlez, vW r Ipproved I�ructio atD 'NALINSPECTION Date )proved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 99201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS W N M O Ifs 0 a a. The undersigned owner/applicant herebyagrees to hold and save harm- less the City of Everett from any and all claims lot damages, costs. expenses. or causes of action that may arise because of Installation and maintenance of the improvement or other right-ol-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Ignature of 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.