1402 SE EVERETT MALL WAY TUX SHOP 2016-01-01 MF Import

Date �L-1��38 ( Application For � PUBLIC VIiORKS PEIRMIT � Print or Type Only �%Yt'_^ 6 �►7 � ��f�� c � �1rG'i'� � Gwner � Maifing Address C Applicant Mailing Describe Proposed Work 1 ( � '�",� �� '� � �� • Prcject Address (if known) Pu�lir, Wo��.a Pnrmi! • 6idB DeD�� — Putils Works Fee Tota� Fee $ — Less ApP� fee PSIU $ — 6alance Oue $ — `'a�5 ��1t�� Zip Phone Attach four (4) co�ies of plans for proposed work - Draw to scale and note the lollowing as • Property Lines • Outline and dimensions of all exro�i^� and proposed structures on the lot • Existing and proUosed utllities • Centerline of streel • Indicate North • Show any proposed grading changes • fihow measurements PERMIT CONDITIONS 1. All calls fo� inspecti.n shall be made 24 hrs. in advance • phone 259-8810. 2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction Standards and Specilications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. i2�-L ��g�«��I Approved lor Construction Da1e FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Streel Everett, WA 98201 Phone: 259-8810 �-�S-BB �� ACKNOWLEDGEMENT OF CONDITIONS � O H � O a The undersigned owneriapplicarit hereby agrees lo hold and save harm- less the City of Everett Irom 2ny and all claims for damages, costs, expenses, or causes ol action that may arise because of inslallation and maintenance ot the improvement or uther right-o4way use herelo applied for and lurther agrees to remove same upon nolice Irom the Ciry and lo replace public property damaged thereby. Signature of Applicant uace 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.