2934 BROADWAY 2018-01-02 MF Import

Eli TYPE OR PRINT ONLY cation For PUBLIC uRKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, 1VA 98201 259-8810 Owner ' /1 / Martino Addre I �Cn Mailing Describe Proposed Work Date Public Works Permit M Building Perruit If Public Works Fee $ --P Phot:e gilOS� City Zip Phone _ PROJECT ADDRESS (if known) 93Y r L2 CQ ,�ly�� LA- Attachfour (4) copies o1 plans for proposed work - Draw to scale and note the foll�wing if applicable. 'Property Lines 'Outline and dimensions of all existing and proposed structures on tte lot 'Existing and proposed utilities 'Centerline of street 'Indicate North 'Show any proposed gradirg changes 'Show measurements uu INUI VVh11It tdtLUW THIS LINE PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advanc,: - 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-M-424-5555. ti;JpLIC W01 i pj;ft Af Y. � OATF.7lYr/y+` Approved for Construction Date FINAL INSPECTION Datc Approved as Constructed W 0 M) z 0 V♦ 0 a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless 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 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.