2216 CLEVELAND AVE 2018-01-02 MF Import

Date Application For PUBLIC WORKS PERMIT Print or Type Only /,'9ni -5y7 - ILJI— Address City Zip Public Worka Paime e '" _ /51 � Bldg Oebl e Public World Fee i TOM Fee Lau Arm roe Paid s —� Balance Due >< _ 5a e - — Applicant Mailing Address Citi Zip Phone Describe Proposed Work Project Address fit known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.801 5. 2. All work shall be performed in accordance with this permit end current City of Everett Design and Coneouchon Standards and Specifications. 3, Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1 •800.424.5555. f � Approved for Construction Date 1_2 2 _r FINAL INSPECTICN Date App laved as Constructed I/eveletl PUBLIC WORKS DEPARTMENT Cedar Ever 8201 Everett, WA'IB201 Phone: 259-d815 ACKNOWLEDGEMENT OF CONDITIONS ca 0 n z 0 0 a The undersigned owner/applicant hereby agrees to hold and save harm. leas 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 pr party damaged thereby. 4 Si nature of Applicant Da WORK AUTHORIZED B'� 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.