2605 81ST PL SE 2018-01-02 MF Import

Date c ,, Application For PUBLIC WORKS PERMIT Print or Type Only Applicant v Public Worka 1 • g3 2 2- Bldg Dept. Publm Works Fn Total Fee f{ Late Appl Fee Paid i Balance Due (J517Jd -70 Y �s3 - Gaa s Zio Phone Mailing Address City Zip Phone Describe Proposed Work _ / 0 �L Project Address (If known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicPhle: • Property Lines • Centerline of street • Outline and dimensions of all existing and • ! idicete North proposed structures on the lot • Show any proposed grading Lhanges • Existing and proposed utilities • Show measurement, PERMIT CONDITIONS 1. All calls for Inspection shalt be made 24 hrs 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 fire. before you dig. TOLL FREE NUMBER 1.800-424.5555. Uj /rrstra r O O a 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 may arise because of Installation and maintenance of the Improvement or other right-of-way use hereto for Construction aPP o d further agrees to remove same upon notice from the Date y andto r71place public property damaged thereby. """ Date _ Approved se Constructed SI velure of Applicant ate WPverptt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTE IS TO Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM T M Y BE Phone: 269-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OFWORK ON THIS PROJECT OVER 90 DAYS DURATION. J