231 74TH ST SE 2018-01-02 MF Import

Date-.FQ-t'�d C� Application For PUBLIC WORKS PERMIT Print or Type Only Public Work, Parma • Bldg Dept e--JB21/l( 71 G �LQ Pubs¢ Work, Fee Total Fee i Lest Appl Fee Paid Balance Due i oC,S / - /'f !!1 -I/— Mailing Address City Zip Phone Atiplicpnt Addre�ss� Zip Phone (Maailing 1InlCity Describe Proposed Work --- W Project Address (If known) _ a 31 — 7V IA' ) �' Attach lour (4) copies of plans lot 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 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 City 0 permit and current of Everett Design and Construction Standards and Specification& 3. Call Location Underground Service 48 hre. befortyou dig. TOLL FREE NUMBER 1.800.424.5555. z X/O aai� j [Cl) 0 an Approved for Construction Date FINAL INSPECTION Dale Approved as Constructed everen PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 88201 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, 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.