1102 84TH ST SE 2018-01-02 MF Import

Date 1-21-93 G-t8-za-5 Application For PUBLIC WORKS PEAR IT, Print or Type Only Public Works Permit • 9 O Bid, DePI • 19321 Public Works Fee Total Fee S Leu Aool Fee Peud Balance Due Tim Standberg PO Box 333 Lakewood WA 98259 659-9586 Owner Mailing Address City Zip Phone Owner Applicant Mailing Address City Zip Phone Describe Proposed Work new hou3e Project Address lit known) Attach four (4) copies c plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • I•idlcale North proposed structures on the lot • Shcw any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hms. In advance - phone 259.8810. 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. C 93 Approved I nstfuctiop Date Date FI fJ-� Approvod as Constructed WORKS DEPARTMENT 45LPUBLIC 3200 Ceder Street Everett, WA 98201 Phone: 259.0810 ACKNOWLEDGEMENT OF CONDITIONS z O O a The undersigned owner/applicant hereby agrees to hold and save harm. less the City it Everett from any and all claims for oamages, costs, expenses, or causes of action that 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 and to "lace pub!ilwjproperty damaged thereby. 6 /v—/J ignature 6 plicant Data OR K A ORIZED BV IS PERMIT MUST BE STARTED WITHIN 180 DAV 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.