6315 FLEMING ST 2016-01-01 MF Import

Date�� ApplicatiOn For PUBLIC WORKS PERMIT Print or Type Only Publlc Works Permlt a 61eB� Dept. • Pub6c Works Fee s Tolal Fee Lass Appl Fee PaiE S Balante Due Applicant Mailing Address City Zip Phone Describe Proposed Work [ �r ��T ' v � �"-'�'` ", `�r�` -� Project Address (if known) Attach tour (4) copies of plans for proposed work • Draw to scale and • Property Lines � Outline and dimensions of all existing and . proposed structures on the lot • Existing and proposed utilities following as applicabie: • Centerline of street � indica�e North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls tor inspection shall be made 2a hrs. In advance - phone 259-8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Stendards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•B00-424•5555. '��- �g. �� :�� .�� y�� B �� o Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Eve�ett, WA 9P201 Phone: 259-8810 ACKNOWLEDGEMENT OF CONDITIONS W H � � O F- � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, wsts, expenses, or causes of action ihat may arise 6ecause of installation and maintenance of the improvement or other right•o(-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 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.