3406 FEDERAL AVE 2016-01-01 MF Import

�ece (�T Applicatlon For PUBLIC WORKS PERMIT Print or Type Only oW�a� Describe Proposed Work Project Address �it known) �� Q City Zip [ip PuEllc Worke Permit � BIUC. Dept. • y �/Y //l PuElic Works Fee TotalFae S Lees AOVL Fee Pa�E S Belanca Oue '�'�p Attach four f4) copies of plans for proposed work • Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed strucWres on the lot • Existing and proposed utilities PEFMIT CONDITIONS • Centerline of street • Indicate North • ShoN any Froposed grading changes • Show measurements 1. All calls for inspection shal� be rnade 24 hra in advance - phone 259•887 5. 2. All work shall be pertormed in accordance with this pe�mit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. �� ✓f�G/C l.tJD.�.f'S f�.B/�7ii iPc�QU��O ��'"B� �� Approved for Construction Date FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3290 Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOWLEDGEMENT UF CONDITIONS W H � � O � � O a The undersigned owner/applicant here6y agrees to hold and sa��e harm• less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because o` installatian and maintenance of ihe improvement or other right-ohway use heieto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Signature of Applicant Date 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.