511 92ND ST SE 2018-01-02 MF Import

Date � �' Application For PUBLIC WORKS PERMIT Print or Type Only PuUI¢ WPrks Pnmlr e Bide 0xPI a_— PPbkc WOO, Fee ` Toler Fee Lee, AW1 Fee Pnd source Due I Zip Pho.te Applicant Medl ig Address City Describe Proposed Work Protect Address (if known) Attach lour 14) copies of plena for proposed work - Drew to Rcale and note the following as applicable: • Centerilne of street • Property Lines • Indicate North • Outline and dimensions of all existing and •Show any proposed Crating changes proposed structures on the lot • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All cells for inspection shell be made 24 his, in advance - phone 259.8815. 2. All work shell be performed in accordance with this permit and current C.4y of Everett Design and Construct, Standards and Specifications. 3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. NO DmeelG efs •c'inii �Egv�¢EO Approved for Construction Date FINAL INSPECTION Date Approved as Constructed i PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS W aata� N In sal Ub O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages. costs. expunses, 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 replace public property damaged thereby. Signature of Applicant 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.