2029 73RD ST SE 2018-01-02 MF Import

Date -yI I act Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Describe Proposed Work _ 4dd r Aav, b) !a_L( — Project Address (if known) Public Wallis Permll a _ Blip Deo, Public Worss rae lolai Fee Less APPI Fee Paid a BelAnce Due i lip Phone Attach four 14) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 his. In advance - phone 259.8810. 2. Ail work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Unrrerground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. Approved for Construction FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 99201 Phone: 259-8810 Dale Date ACKNOWLEDGEMENT OF CONDITIONS W H CA M O W) 0 an 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 to replace public property damaged thereby. Signature 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.