4529 FEDERAL AVE 2016-01-01 MF Import

Applicetlon For PiJBLIC WORKS PERM�T Print or Type Only Puplic Wo�IU P�r • `� � `�� dICp.O�pt • T � — Pu01k Worlu FN ` To1H Fea Ua Appl F�� P�Itl � Bxbncs Du� { �� naaress Describe Proposed Work _ . Profect Address (it known) Attach four (4) copien of plene f�r Dropoaed work • Drew to scale and note the following as appliceble: • Property Lines • Outline and dimenaions o1 all existing and propoaed atructurea on the lot • Exintinp and proposed utilities • Centedine of street • Ind�ca�e North • Show any proposed gratling changes • Shcw measurements PERMIT CONDITIONS t. All calls for inspection shall be made 24 hrs in advance - phone 2S9•881 �. 2. All woric shell be pertormed in accordance with lhis permit and current City of I_verett Design and Construction Standards and Specilicationa 3. Call Location Underground Service 4B Ara before you dig. TOLL FREE NUMfiEH 1•800-424•5555. f�lo �7� .� /�� 6 A �proved for' onstructionA _ � Te�e Approved as Constiuctetl everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Evorett, WA 98201 Phone: 259•8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � � � � O a The undersigned owner/apDlicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, cost& ezpenses, or causes of action that may arise because of instellation and maintenanca of the improvement or other right•ol-way use hereto applied for and I;:rther agraes to remove same upon notice from ihe City and to replacu public property dam d thereby. Si nature wa' _, Da e 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 B£ CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.