1506 81ST PL SE 2018-01-02 MF Import

DBtej1V3 Application For PUBLIC WORKS PERMIT a` Public Work. Pnrmil . F-3 slog- DIP,. e Pub W.k.k. Fe. ��, C' (] Total Fee Lee. ADD( Fee PAW B.I.M. Due i Print or Type Only (014 a Zip rnm,a Describe Proposed Work Jr I- JLuD --ral(f i2lUfIT L l'- c NL :If),� — i /Sa(a $� ai Pl SE Protect Address (II known) �— Attach four (4) copies of plena for proposed work - Draw to scale and note Centerline as of applicable: S Property Lines • Indicate North tillOutline and dimensions of all existing and Shaw any proposed grading changes proposed structures the lot 9 Show measurements • Existing and proposedd utilities PERMIT CONDITIONS 1. All cells for inspection shall be made 24 hrs. in advance - phone 259.8815. 2. All work shell be performed In accordance with this permit end current City of Everett Design and Construction Standards and Specificalionb. 9. Cell Location Underground Service 48 tire, before you dig. TOLL FREE NUMBER 1.800.424.5555. TAD �o c<c�lu. apfJro ��b� Plet v," � tZ-tt-t[j roved for Construction Date i t c'yy--, FINAL INSPECTION Data %pproved as Constructed everntt PUBLIC WORKS DEPARTMENT Q 3200 Ceder Street Everett, WA 98201 Phone: 259.8815 z 0 FoR 0 an 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 Play 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 C�ty and to replace public orpperty damaged thereby. Signature of Appkcant r ---- WORK AUTHORIZED OFF DATE PERMIT E H SSUED AND EREAFTER ISRMIT MUST BE STARTED H IN 80DAYS STO 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.