4529 FEDERAL AVE 2016-01-01 MF Import

Date.S�-�� Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Publm Woiks Permil ♦ �,� < <- BI09. DePt. � ��.�� Pu01ic Works Fee s Totel Fae Less Appl. Fea Paitl S Balanco Due S � Phone S �'L„ �-� Applicant Mailing Address City ZiP Phone Deacribe Proposed Work � � ��' Pro)ect Addreea (If known) Attach four (4) coplea of plens (or proposed work • Draw to scale and note the following as appliceble: • Property Lines .• Centerline of street • Outline and dimeneions of all existing and • Indicate North propoaed atructures on the lot • Show any proposed gradir�g changes • ExiatlnB end propoaed utilities • Show measureinents PERMIT CONDITIONS t. All calle tor inepectlon shall be made 24 hrs. in advance - phone 259-8815. 2. All work ahell be peMarmed in accordance with ihis permit and current City of Everett Design and Construction Standarda end Speclticetiona 3. Cell Locatlon Underground Service 48 hrs. betore you dig. TOLL FHEE NUMBER 1•800•424•5555. �ii0 f�GcJ — /�E.QM/l �EQ Approved tor Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Sireet Everetl, WA 98201 Phone: 259-8815 �� a/87 `�� ACKNOWLEDGEMENT OF CONDITIONS W H � � � � H V) The undersigned owner/applicant hereby agrees to hold and seve herm- less thn Cily of Everett Irom any and all cleims for damages, c�sts, expenses, or causes of action that may arise because of Installation and mainlenance of the improvement or other right-oi•way use hereto 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 5TARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.