6923 COLBY AVE 2016-01-01 MF Import

oate �� / � 6 Appilcation for PUBLIC WORKS PERMIT Print or Type Only Mailing Applicant Pubhc Wo�YB Parmu • �- y:�.� a�ao.oeo�., r9/.� — /J�.�� Cubiit Worka Fee Tol�l Fea S - Lesa Rppt Fee PeiC S�_ Be�ance0ue f ��'- (oSa •- Giry Lp Phone Describe Proposed Work CDiLST.pGCT S, F,C�' _ Proiect Address �il known) Attach four (4) copies of plans for proposed work • Draw to scale and note the lollovring as applicable: • Property Lines • Outline and dimensions ol ell exislinp ar..i proposed structures on the lot • Exi�ting and proposed utilities • Centerline of street • Indica�e Norlh • Show any proposed grading chenges • Show measurements PERMIT CO�'DITIUNS t. All calls for inspe,;ion shall be made 24 hrs. in advance • phone 259•8815. 2. All work shall 7e periormed in accordance with this permit and current City ol Eierett Design and Construction �tandards and Specifications. � 3. Call Location Underground Service 48 hrs, belore you dig. TOLL FHEE NUMAER 1•800•424•5555. � hW CGr�'B/ GU�c�',G' GS�' SipEWAG.0 l)y/r�HGE� Bj/ �E .9.��Ci.^Ai✓T Syf/CC 6'E' �EP.�AGEo /3� 7.v£' �/�I�LiG.an/% . Date Date Approved as Constructedv everett PUBLIC WORKS C � 3200 Cedar Streel Everett, WA 98207 Phone:259-8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � � � O � � � a The undersigned owner/applicant heieby agreE� to hold and save harm- less the City ol Everett irom any and all claims lor damages, cosis. expenses, or causes of action thal may arise beca�se of installation and maintenance of the improvement or olher right-ol-way use herelo applied lor and luriher agrees to remove i.ame upon notice hom Ihe City and b replace public property damaged Ihereby. Signature ol Applicant ' Date WOFK AUTHORI2ED BY THIS PERMIT MUST 8E STARTED WITHIIJ 780 DAVS OF DATE PERMIT IS ISSUED AND THERE-AFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BC CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI ; PROJECT OVER 90 DAYS DURATION.