6500 EVERGREEN WAY ST VINCENT DE PAUL 2016-01-01 MF Import

Date � %� � 7 Appli^alion For PUBLIC WORKS PERMIT Print or Type Oniy Mailing Address Describe Preposed Work �,li ��!! �L��CHT]l�l �� Project Address (if known) Public Works Pcrmit r ema.000�.x �� "�� Public Works fea Total Foo S I.ess AppL Fca Pald $ Betance Oue $ i 'r -125�� / Z�P Phone Attach four (4) copies of plans for proposed work - Draw to scale ar�d note ihe following as applicable• • Property Lines • Outline and dimensions oi all existing and proposed structures on the lot • Existing and proposed ntilities PERMIT CONDITIONS ! Centerline of street • Indicate North • Show any proposed grading changes • Show measuremenis 1. All calls for ir.spection shall be made 24 hrs. in advance - phone 259-881 5. 2. All work shall he performed in accordance with Ihis permit and current Ciry ot Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. � �c� �x�l�l i c Approved for Construct f..l�C�►�� .��'��l'Yll� 7/�g 7 � ACKNOWLEOGEMENT OF CONDITIONS � � ♦�A V+ OA 1.�. The undersigned owner/applicant hereby agrees to hold and save harm- �less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and mainter�ance ot the improvement or other righl�ol-�.vay use hereto I applied for and further agrees to remove same upon notice from ihe Date City and to replace public property damaged ihereby. FINAL INSPECTION Date Approved as Constructed evere[t PUBL!� WORKS DEPARTMENT � 3200 Cedar Sireet Everett, WA 98201 Phone:259-8815 Signa2ure of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI7HIN 180 DAYS OF DATE PERMITIS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.