2132 COLUMBIA AVE 2016-01-01 MF Import

�. Date 6/9/9L PUEI1cWork�P�rmi1 3rn� OJ B�Ep.Depl.• Application For PUBLIC WORKS PERMIT PueToiaFeeFea = - Lesa Appl Fee PsiO S— Bd�oce Due f Print or Type Only , Jackson, Curtis/Wendy 2132 Colambia Ave Everett 98203 348-3951 Owner Mai4ing Address City Zip Phone �FRIEI Applicant Mailing Address City Zip Phone Describe Proposed Work W Project Address(it known) 2132 Columbia Ave � Attach four(4) copies of plans for proposed work• Draw to scale and note the following as applicable: � . � PropeAy Linea • Cente�•line of street � • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed greding changes • Ezisting and proposed utilities • Show measurements M W DO NOT WRITE BELOW THIS�INE O PERMIT CONDITIONS � 7.All calle for fnspsCtbn ahell be mede 24 hrs.in advence-phone 259-8810. 2.All work shall be peAormed in accordence with this permit and current City of Everett Design and Conatrudlon Slandards and Specification3. � � 3.Call Locetlon Underground uervice 48 hrs.before,you dig.TOLL FREE NUMBER 1•800�4245555. P 6.� ��:.�.�,�.,�=� /�� ,��,�� =� ~ /�-/S- �Z � O a ACKNOWLEDGEMENT OF CONDITIONS The �ndersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett Irom any end all claims for damages, costs. � expenses, or causes of action that may arise because of installation and maintenance ol Ihe improvement or other right•ol-way use hereto applied for and further agrees to remove same upon notice irom lhe Approved tor Construction �a�e City and to replace public property damaged thereby. . FINAL INSPECTION Date Date . Approved as Constructed Signature of Applicant WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � PUBLICWORKSDEPARTMENT 160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259-8870 PROJECT OVER 90 DAYS DURATION.