2602 81ST PL SE 2018-01-02 MF Import

Date'3 Application For PUBLIC WORKS PERMIT Print or Type Only Sf�115 lio�oX I�S� Address Public Wore, Permit a IQ �+D adv Dort Off-7/ /a 9/ 3 Public Worka Fee 70141 Fee Lest APO[ Fee Paid s Balance Due 6G/3k 5%- 70 7 0 Phone it Mailing Address City Zip Phone Applicant g Describe Proposed Work S-/ A/9 /Q -'A'y� O 61° I20M771r4CTtd Project Address (if known) 2 (,.. 0 Z 5, Attach lour 141 copies of plans or propiosed work • Drew 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 PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hra in advance • phone 259.8815. 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. -�J Date Date Approved as Constructed W PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS W I- U) m O 0 O a 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 causes of action the'. 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 upon notice from the City end to replace p plic propertymeged (hereby. Sip ure of Applicant I O'9 were WO AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO RE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.