2422 81ST PL SE 2018-01-02 MF Import

U __1 Date -?I-K Application For PUBLIC WORKS PERMIT Print or Type Only S e) 11 S I f, I C City Public Wont Perms a !+ 2 3 91da Debt e _ Public Wmke Fee O Q Tblel Fee Less AppL Fee Paid S Balance Due i 4 • O o 6' f/7 ' 06 �579- 740 7 0 Applicant Mailing A-Jress City Zip Phone Describe Proposed Work Project Address (if known) 1S Q 1i'1 SE UJ Attach four (4) copies of plans for proposed work - Draw to scale ,nd note the following as applicable: o • Property Lines • Centerline of street ♦ j� • Outline and dimensions of all existing and • Indicate North v+ proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hru, in advance - phone 259.881 5. 2. All work shall be performed in accordance with t9is 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. for Construction Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 98201 Phone: 259.8815 r 1 I••J U) O a ACKNOWLEDGEMENT OF G(JNDITIONS The undersigned owner/applicant herebyagrees to hold and save harm- less the City o! Everett from any and all claims for damages. costs, expenses, or causes of action that may arise because of Installation )/ 41 and maintenance of the Improvement or other right-oFway use hereto applied for and further agrees to remove same upon notice from the Date City and to replace Rublic property damaged thereby. Date Sig ure of Applicant Date WO 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.