511 72ND ST SE 2018-01-02 MF Import

Dated Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Ar) I t Describe Proposed Work Project Address (if known) h01— -- —c_j _ Public work, Permit eldp Dept , Public Work, Fee Total Fee i Lou Appl Fee Paid Balance Due Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines M 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 Shall be made 24 hrs. In advance - phone 259.81315. 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 fire. before you dig. TOLL FREE NUMBER 1.800-424.5555. No ,emir �'Fga�APEv,� s�Z3�ec G9e�'iDlrE LGCA�io.t% iPE!/asE.O� Approved for Construction Date FINAL INSPECTION Dale Approved as Constructed everetl PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 982018201 Phone: 259-8815 ACKNOWLEDGEMENT OF CONDITIONS W N IIm O M) z O O a The undersigned owner/applicant hereby agrees to hold and save harm. less 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 t replace public property damaged thereby. Signature of Aftpllcant 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.