820 90TH PL SE 2018-01-02 MF Import

Date-j/0 Application For PIJ13LIC WORKS PERMIT Print or Type Only �C Puplk Works p.rmn a _ � �/— <L j Aldo Pool. a _1Q�i Pubk works Fee Total Fee Leas Appt Fee Paid $ 8aiance Due S 20, 04:7 .;73 //0 ron,11 n� �c ZCz S 3s3 - HSU Ow„ar MaiNng Addres�`�C11—'�" ��" �yAp Phone g�lr Lam_ Applicant Melling Addreaa - City Zip Describe Proposed Wort Project Address (if known) _ _ Attach four (4) copicill of plars for prepared work - Draw to scale and note the following as a licable: • Propert Linea •Centerline treat • Outline nd dimensions of all existing and • Indic urth prdppsed structures on the lot • Existing and proposed utilities w any proposed grading changes 0 Show measurements PERMIT CONDITIONS 1. All calls for Inspection shall ba made 24 his. 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. Cali Location Undergrourd Service 48 fire. before you dig. TOLL FREE NUMBER 1.800.424.5555. Approved for Construction Date 7- J-� FINAL INSPECTION Date Approved as Constructed i PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS Im wO z O V.� ron O CL 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 t: a Improvement or other right-ol-way use hereto applied for and further agrees to remove same upon notice from tree City and to replace public property damaged thereby. �' \J 1!/ddA hIM N. Y� 9 —L� Signature of Applicant Dale WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEPEAFTER 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.