2310 73RD ST SE 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only ,'ubLc Works Pe,mn . � I —. slag pool . PMnc Work. Fee s Tolel roe Less Apo[ fee P.,. S BtlAnce pus S _ /W /} I—/- W'4 y /}5 ls� /.?;tsaroya4a:ir 98;fpy 3A+9_3C3'tJ'- Owner Melling Address City Zip Phone S•/{- /Ien Z — -- Applicant Melling Address City Zip PI one Describe Proposed Work^ W Project Address (if known) Attach four 14) copies of plans for proposed work • Draw to scale and note the following as applicable: trrrl� • Property Lines a Centerline of street Cn • Outline and dimensions of all existing and a Indicate North proposed structures on the lot a Show any proposed grading changes . • Existing and proposed utilities • Show measurements wA Wt DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS O 1. All calls for inspection shall be made 24 hr-. In advance • phone 259.8815. 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 hrs.before you dig. TOLL FREE NUMBER 1.800.424.5555. z 09/11/06 10:31AM DOOA4189 / Df'T.2U s20.00 O CHECK $20.00 am W PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages. costa expenses. or causes of action that may arise because of Installation and maintenance or the Improvement or other light -of -way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. 4 Signature of Applicant Dale 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.