6505 BEVERLY BLVD 2016-01-01 MF Import

Date �//� Applicefion For PUBLIC WORKS PERiVInT Print or Type Only �'�-0 �I '� . Zip Describe Proposed Work ��L I� �� y�� Prolect Address (if known) Puel¢ Works Permlt i _ _ Biaq Oepi • � _ PuELc Worb F•e s Talel Fee Leb ADP� Po! PeIC S BnbnceDue S Atlach lour (4) copies nt plans �or proposed work - Draw to scale and note�the lollowing as applicable: • Property Lines • Centerline of sireet • Outline and dimensions of all existing and • Indicale Norih proposed st�uctures on the lot • Show any proposod gradiny changes • Ezisting and proposed utilities • Show measuremenls PERMIT CONDITIONS t. All calls for inspection shall be made 2a hrs in advance - phone 259-8815. 2. All work shell bo performed in accordance with this permit and current City of Everett Design and Const�uclion Standards and Specifications. 3. Call Location Underground Service 48 hrs. befo�e yo� dig. TOLL FREE NUMBER 1•800-424•5555. �Gc� fF,O/n/T �T .��y�Gi.rt'� .O Approved lor Construction Uate FINAL INSPEC710N Date AUproved as Consiructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everetl, WA 98201 Phone:259�8815 lo��j86 ��. �CKNOWLEDGEME�" 7F CONDITIONS W F- � � O � � O a The undeisigned owner/applicant hereby agrees to hold and 5ave harm- less the Cily ol Everetl irom any and all claims lor damages, costs, expenses, or causes ol action that may arise because of installation and maintenance ol :hc improvement or other righl-ol�way use hereto applied for and lurther ag�ees to remove same upon notice Irom the City and lo replace public p�operty damaged thereby. Signature uf Applicant Date WORK AUTHORI2ED BY THIS PERAiIT 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 8'! THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 D4YS DURATI01..