3920 NASSAU ST KOA KOLLARS 2018-01-01 MF Import

�:: 'L S PUBLL�C WORKS PERMIT Date: 2/5/2010 Ciry of Everett P.ublic Works p,��n�S,� Public Works Permit #: PW1002-004 320 4 dar Stree .�-G4-GV��JIWcD) 15:10 Buildinp Permit #; Eve�t��A 9820 ��G-1 O�bl (425) 257-8810 CT �lanninq Reference #: FEfMIT No.100�004 Public Works Fee $: $ 308.25 o utner �: OWNER NAME AND ADDRESS: TL J��L��NT NAME AND ADDRI=SS: KOA KOLLARS '��`D SA�•�� P.O.BOX 12278 MILL CREEK �/yq 98082 PHONE: 4254829806 PHONE: TAX PARCEL ID # SITE ADDRESS: 3920 NA."iSAU STREET DESCRIPTION OF PROPOSED WORK: SEWER EXTENTION F'tKMI l GONDITIONS 1. All calls for inspection shall be made 24 hours in advance. 2. All work shail be pertormed in accordance with the permit and current Ciry of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 811 � Construct per approved ptan. �� PQSTING i�-�'- '= �� r �� %i LifZ`�%�' �'f j -� Approved for Construction Date FI as Constructed Date —Z:= —/b W E"� � � � O � z 0 H � 0 a ACKNOW LEDGEMENT OF CONDITIONS The undersigned owner/applicanl hereby agrees to hold and save harmless the City of Everetl from any and ail claims for damages, costs, expenses, or causes of action that may arise Eecause of instailation and maintenance of lhe improvement or other right-of•way use hereto applied for and furiher agrees to remove same upon noti from the City and to replace puh�ic p perty dam e t � -� �� Slgnalure of Applicant Date WORK AUTHORIZED BY THIS PERMR MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO COMPLEiION. THIS PERMR P1AY BE CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS PRO]ECi OVER 90 DAYS DURAi70N.