615 80TH ST SW 2018-01-02 MF Import

Date 9 / 493 I Application For PUBLIC WORKS PERMIT Print or Type Only IT Melling Describe Proposed Work .61, a"c/l Ik Project Address (if known) Public Works Permit Bldg Dept, e r r — Pubic Works Fee >i 7a(j. Total Fee Less xppt Fee Paid t{ Balance Due a t,PPr/i °IC& 1 1-6-1- 2l S/ Zip Phone Lip Attach four (4) copies of plans for proposed work • Draw to scale and note t Centerline of sU eelt able: • Property Lines •Indicate f•lorth • Outline and dimensions of Pit existing and • Show any proposed grading changes proposed structures on the lot • Show measurements • Existing and proposed utilities PERMIT CGNDITIONS 1. All calls for inspection shall be made 24 hra. in advance • phore 259.8815. 2. All work shell be performed In accordance with this permit and current City of Everett Design and Construction Standards and Sne,ificatlone 0. Cnll Location Undercround Service 48 hra. before you dig. TOLL F E rNUMBER �c1.r8i0/0.42w4o.r5e,5�5-/ . "'I //n o .4 P2 vo /� 4s �+Q�./irPcG 'f'i✓ LLt?�/ •� r/ h-�' S r !1�_- war� . -Apprdved for Construction r Dele FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Eve-ell. WA 982018201 Phone: 259.8815 co IO z O O a ACKNOWLEDGEMENT OF CONDITIONS The d and save harm- less the eCity nof Everett ed afroim any and all icant hereby gclaimsrees o food 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 •tpon notice from the :City and to replace publl arty damaged thereby. Date C� Signatur of Applicant 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.