4503 FEDERAL AVE 2016-01-01 MF Import

Date�� Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address Sr. i N � � � � O O � � 'r��. � � N N r � Ci�y � � • N � � �� City PuDlie Works Permll � _.. � /O� / eiev� oeo�. + Public Worxs Fea Totel Fee S Lasa POG� Fee PaIC S Balance �ue S �� (0.�' zS2- Phone Describe Proposed Work ��LL - il �l�'� /q % /�%d'D v� �-o c.4. jio l�_ �u Prolect Address (if known) sGi��'� �JI — /�ttach four (4) copies of plans for proposed work - Draw to scal�� and note tne following as applicable: • Property Lines • Centerline o1 street • Outline and dimensions of all exisling and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing antl proposed utilities • Show measuremenis PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 258•8810. 2. All wcrk shall be performed in accordance with this permit and current City of Everett Design and Consiruction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. Y'��e� 2--e1' %�f' Approv d for Consiruction /' Date _��.%�C-^ _— � • /J . �il _ FINAL INSPEC�ION D�te Approved as Constructed �A��PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 98201 Phone: 259•BB10 .4CKNOWLEDGEMENT OF CONDITIONS W � � � � O a The undersi9ned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims tor damages, costs, e■penses, or causes of action that may ariae because of installation and maintenance of the improvement or other right•of-wey use hereto applied for and further agrees to remove seme upon notice irom the City and to replace public property damaged thereby. "— a'��"% Signature of Applican De�e WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS I; SUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOfiK ON THIS PROJECT OVER 90 DAYS DURATION.