9609 EVERGREEN WAY 2016-01-01 MF Import

,�e 30 9 !L qpplication For PUBLIC WORK;S PERMIT Print or Type Only �� ling Address C��Y tver9•-t r Wc, y .Y��S_ �J ilinq Address ��Y Describe Proposed Work 5.�.,Lc�� VY%�✓[' f ' ,.2-5 :. �.rcQS Publ¢ Works Pe�mil � BItlB� DeO�. � - PuelicworksFee $ Total Fee LesSApO�. Fee Pald $ /' � Balance Due S S- Zip Phone Pwject Address (if known) �� Attach four (4) copies ot plans for proposed work - Draw t� scale and nole the following as applicable: • Property Lines • Outline and dimensions ot all exisling and proposed structures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any prnposed grading changes • Show measu�ements PERMIT CONDITIONS 1. All calls tor inspection shall be made 24 hrs. in advance - Phone 259-8810. 2. All work shall be peAormed in accordence with this perm�t and current City of Everett Design and Construction Standards and Specitications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. S� /j��' Gc:.� .��2��-f� ��Ctiv.l �/ ��L'F fi.n-u=� �� ^�� L .u.��„ �-�,� 6 � o��, ��f/ � �� t �„�,�-�- ��,,�� . Approved as Constructed �A�I�PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everatt, WA 98201 Phone:259-8810 -26SZ7 ACKNOWLEDGEMENT OF CONDITIONS � O �"' � � a The undersigned owner/applicant hereby agrees to hold and save harm- less ihe City of Everett from any and all claims for damage�, costs, e■penses, or causes ot action that may arise because of installation and maintenance ot lhe improvement or other righhof•way use hereto applied for and further agrees to remove same upon notice from ihe Ciry and to replace public property damaged lhereby. � i'�v✓ Signat e of Applicant Date WOR t 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.