7807 EVERGREEN WAY PICWAY SHOES 2016-01-01 MF Import

Date��c47 � Application For PUBLIC WORKS PERMIT Print or Type Only ,=_. Pubpc Works Parmlt + o 6100� DopC + � / �� PubticWorksFao 5 Tatal Foo Loss Apo� Feo PaiE $ Balnnce Duo Describe Proposed Work Project Address (if known) Attach tour (4) copfes of plans (or proposed work • Drav • Property Lines � Oulllne and dimenslons ot all existing and �roposed structures on the lot • Existing and proposed utilities scale and note the thUbwing as applicable: • Centerllne of slreel • Indicale North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspectfon shall be made 24 hrs in advance - phone 259-8815. 2. All work shall 6e performed in accordance with this permit and current City of Everett Design and Consiruclion Standards and Specifications 3. Call Location Underground Service 4B hrs before you dig. TOLL FREE NUMBER 1-800�424-5555. / Ul'G /C Cv��,�s' �c/�iriir .a/o�' �E�G�i,E��o Approved for Construction 8/25�/g 7 �l�"� ACKNOWLEDGEMENT OF CONDITIONS W � � � � 0 ♦�A V� O � The undersigned owner/applicant hereby agrees to hold and save harm- less the City o( Everett from any and ell claims for damages, costs, expenses, or causes of action that may arise because of Installation and maintenance of the improvement or other right-ol•way use hereto applied for and further a9rees to removo same upon notice (rom the Date City and to replace public property dama�ed thereby. FINAL INSPECTION Date qpproved as Constructed everet[ PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259•8815 Signature ot Applicant Date WORK 4UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE �;LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.