709 N BROADWAY 2016-01-01 MF Import

� Date l`�/� Application For PUBLIC VWORKS PERMIT Print or Type Only Address MaP�ng Address Describe Proposed Work Prcject AAdress (il known) Pu01¢ Works Permlt • 1 ema. oeo�. • ��'Z�l !_-- Publ¢Wo�M�.Gea s Totai Fee less ADGI Fee Paid � — 9aiance �ue ' Zip �hone Attacb four (4) copies ul plans for proposed work - Draw to scale and nole the following as applicable: � Property Lir.es • Centedine of sireet • OuOine and dimensions ol all existing and • Indicate North proposed sfrucWrr.s on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measuremen�s PENMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All work shell be pertormed in accordance with this permit and current Ciry of Everett Design and Construction Standards and Specifications. 3 Call Location Underground Service 48 hrs. before you dig.'� OLL FREE NUMBEfl 1•800•424•5555. �Ur�.� C;�v�ln��,,�� , Approved lor Con,truction FINAL INSPECTION Approved as Consiructed everett PUBLICWORKSDEPART � 3200 Cedar Street Everett WA 98201 Phone:259�8810 /o�z�� g �� ACKNOWLEDGEMENT OF CONDITIONS W H � � O � � � a The undersigned owner/applicant hereby ag�ees to hold and save harm� less ihe City of Everett irom any and all claims for damages. costs, expenses, or causes ol action that may arise because of installa!ion and maiMenance of the improvement or other right�obway use hereto applied for and furth=r agrees to remove same upon noiice from the City and to replace public property damaged Ihereby. Signature of Applicant Date WORK AUTHORIZ[D BY THIS PEHMIT MUST BE STArIiFD WITHIN 180 DAYS OF DATE PERMIT I� ISSUEU AND THEREAFTER IS TO BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.