1510 81ST PL SE 2018-01-02 MF Import

Date_iZk3 Application For PUBLIC WORKS PERMIT Print or Type Only Describe Proposed Work Public Work$ Permit e Bldg Dept, Pubt, Work$Fee Two]Foe _ Less Epp, Fee Peid Seen* 66,G .6 Zip Phone P� 1i I�J� V P 'Tit ei _� I [ e r ,- •-y ,=cam 1�, �?+� /„� l / S i c7 Ff / S- ,o • S E - Project Address (if known) -- ONo Attach lour (4) copies of plans for proposed Work • Drew to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North • Shcw any proposed grading changes proposed structures on the lot • Show measurements • Existing and proposed utilities DO NOT WRITE BELOW THIS LINE n PERMIT CONDITIONS I^ 1. All cells for inspection shell be made 24 hr& in advance • phone 259-881 5. i 2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell Location Urderground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.55 0 ]® 1 l "NppfDyed for Conslructlon Dete FINAL INSPECLL TION Dete Approved as Constructed event[ PUBLIC WORKS DEPARTMENT 3200 Cedar 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 cautes of action that may arise because of installation and maintenance of the Improvement or other r,ght•of•way use hereto applied for and fu, that agrees to remove same upon notice from the City a d.to replace public property damaged thereby. -Signature of Applicant / Cate 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. yamy, 0 C r