6020 EVERGREEN WAY 2016-01-01 MF Import

Date Applica�ion For PUBLIC WORI�S PERMIT Print or Type Only Applicanl Describe Proposed Work Project Address 1if known) mawng Mailing Address Attach lour (4) copies ol plans for proposed work • Graw to scale and note • Property Lines • Outline and dimensions ol all existing and proposed structures on lhe lol • Existing and proposed u�ilities a�er� wa�ks re��/(%� t� J�—i Bltlg DeO�- � —_ll1 Pu�i¢ Wortb Fee To�a� Fee �6 Le¢s AoO�� Fee PaiE S 9alance Oue $ th�'following as applicable: • Centerline ot streel • Irdicate North • Show any proposed gradin� changes • Show measuremenls PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All work shall be performed in accordance with lhis permit and current Cily of Everett Design and Construction Standards and Specificatlons. 3. Call Location Underground Service 4li hrs. before you dig. TOLL FREE NUMBER 1-500•424•5555. �ot �� . �� �-22-`� Approved lor Consiruction Date FINAL INSPECTION Oate Approved as Conslrucled everett PUBLIC WORKS DEPARTMENT � 3200 Ceder Street Everett, WA 98201 Phone:259�8�10 ACKNOWLEDGEMENT OF CONDITIONS W H � � 0 H � � a The undersigned owner/applicant hereby agrees to hold and save harm- less the Ciry of Everett Irom any and all claims for damages, cosis. expenses, or causes of action Ihat may arise hecause o� installation and maintenance ol the improvemenl or other right-ol-way use hereto applied lor and luriher agrees lo remove same upon notice irom �he City and to replace public property damayed thereby. Signa�ure of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE C�ILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PFOJECT OVEA 90 DAYS DURATION.