824 90TH PL SE 2018-01-02 MF Import

Date*440 Application For PUBLIC WORKS PERMIT Print or Type Only Public Works Permit • 6K I_, .2/;7 alto Dept a er. y Public Works Fee Total Fee S Leas Appl Fee Paid S Balance Due $ 2�^ m„ NCwL%?iyLt . r 7/ �i SF_ L",J�Ne,19aUlwln.,. 3 53—(c-5'o''�/ el O-w. ner Malling Address City zip Phone Applicant Mailing Address City zip Phone D qq f Describe Proposed Work d f Q�%J y Oit!•L[Pw,��LeQ Project Address fit known) Attach lour (4) copies of plans for proposed work • Draw to scale and note the following as applicable: trrrrrrr� • Property Lines • Centerline of street /A • Outline and dimensions of all existing and • Indicate North v♦ proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE 0 PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs. In advance • phone 259.881 5. 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 cREE NUMBER 1.800.424.5555. z Approved for Conn1n ouc Ionp �� X Dale FINAL INSPEC N ate Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 everett Phone: 259.8815 Fm 0 a ACKNOWLEDGEMENT OF CONDITIONS The undersigned ownertapplicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, coals. expenses, or causes of action that may arise because of Installation and maintenance of the Improvement or other hghl•cl•way use hereto applied for and further agrees to remove same upon notice from the City and to replace public droperty damaged thereby. algillature of Apo nl Date WORK AUTHO 1 D BY THIS PE MIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TC BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY F CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON Ti PROJECT OVER 90 DAYS DURATION.