5930 EVERGREEN WAY BASE FILE 2016-01-01 MF Import

Date �� Applicatinn For PUBLIC VIlORKS PERMIT Print or Type Only K� ,- — Owner T Applicant Describe Proposed Work x Address Address Zip Zip �3�Pu01ic Woiks Perm�l • BIQg.0ep1. • Publie Worb Fea $ Total Fea La9a APO� F!a Pa1E S� f 7 �% � Balence Dua � .i � Project Address (it kmwn) - -- Attach four �4) copies ol plans for proposed work • Draw lo scale and note the following as applicable: • Properry Lines • Outline and dimensions of all existing and proposed siructures on the lot • Existing and propoaed utilities Vi4 cG� - � ,� s�n� Phone • Centerline of sireet • Indicate North • Show any proposed grading changes • Show measurements Phone PERMIT CONDITIONS 1. All calls tor inspection shall be made 24 hrs. in advance • Phone 259-881 5. 2. All work shall be performed 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. TOLL FREE NUMBER 1-800•424•5555. � �� �o� �-�,P-.�� , .� � Approved as Constructea everett PUBLIC WORKS OEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOW�EDGEMENT OF CONDITIONS � O �" � 0 a The undersigned owner/applicant he�eby agrees tu hold and save harm- less the CitY of Everett from any and all claims for damages, costs. expenses, or causes ol action lhal may arise because ol installation and maintenance of the improvement or other righbof-way use herelo applied lor and lurther agrees to remove same upon notice from lhe City and to replace �c pwperty damag�d thereby. \ —��lZn Q ( J�(�,�/ � � ' 2 � �3 Signature ol Applicanl 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.