814 89TH ST SE 2018-01-02 MF Import

Dateys Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Describe Proposed Work -- Rs ps Public: Worb permit sift Dept, Y'.�//�f�6•2, Publq works Fee Total Fee Less April Fee POW t{ Goon* Ills %t-- r CI„ ` Zip Phone _ Project Address (if known) S�e — cQ9=' SY. S_E. City Zip Phone Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline M sheet a Outline and dimensions of all existing and • indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measuremel is salsa DO NOT VvHITE BELOW THIS LINE PERMIT CONDITIONS 1. All calls for inspection shall be made 24 firs, In advance - phone 259.881 5. 2. All work shell be performed In accorri.,nce with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell Location Underground Selv'ce •13 firs. before you dig. TOLL FREE NUMBER 1.800.424.555°. Approved for Construction / u1i18 .`��,L/ INSPECTION O' to >pC roved as Constructed D PUBLIC WORKS UEPART MENT Ever Cedar SirnA. Everett. WA 98:-01 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS M 0 n Z. 0 Cl) � 0 am 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 b3cause of Installation and maintenance of the improvement or other right-of-way use hereto applied for and further agreos to remove same upon notice from the City and to replace public property damagnd thereby. Signature of Applicant r / Date 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.