1011 90TH ST SW 2018-01-02 MF Import

Date Public Works Permit # Application For .a Bldg. Dept. # 1 PUBLIC WORKS PEe I T Public Works Fee $ 4S'4/ r Total Fee Cl 0 Less Appl. Fee Paid CE C`J — Lf7 � *+3 �;r L+7 Balance Due Print or Type Only r- cD r- na y L 114 LUa `sS_A07 Owner Mailing Address 6r ` • r..'s u can't r'-e «' Zip Phone ., wa C,a r•,t 91':*0irl" C;a ca , 0- M C.,.i P•? C3 t•—t F- ',, Cal :s-: UJ 'LtutiC aw'A r"I Applicant Mailing Address City Zip Phone Describe Proposed Work &lzz' W Project Address (if known) z alz s Attach four (4) copies of 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 • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS O 1. All calls for inspection shall be made 24 hrs. 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. Cl) Q. ACKNOWLEDGEMENT OF CONDITIONS 6LPUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8810 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 applied for and further agrees to remove same upon notice from the. City and to re.Qlace public property damaged thereby. d g ture of A Drate. ORK AUJKORIZED BY THIS P IT MUS 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.