1505 81ST PL SE 2018-01-02 MF Import

Datewee Application For y PUBLIC WORKS PERMIT Print or Type Only r.� Owner // Mailing Address City Zip Public Works Permit* Bldg. Dept. # Public Works Fee Total Fee $ Less Appl. Fee Paid $ Balance Due $ �d Phone Applicant Mailing Address City Zip Phone Describe Proposed Work Project Address (if known) Attach four (4) copies of plans for 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 1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. 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. �lC •�-�,�% chi a." --2e Ds Approve;fC nst c io FINAL INS - CTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8810 ACKNOWLEAAWO0300IM 1$46 *;#** The undersigned owner/applic �& agrees to hold and save harm- less the City of Everett fro II claims for damages, costs, expenses, or, causes of action may .4xG.E&ause of installation and maintenance of the imprMKnt or o „0ght-of-way use hereto applied for and further agrees to remove same upon notice from the Date City and to replace pyblicprop 5pty dgnaged thereby. ( Date Signa re 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.