620 SE EVERETT MALL WAY SUBWAY 2016-01-01 MF Import

Date�LJid''1 � Application For PUBI�IC WORKS P�RIVIIT Print or Type Only Mailing Addre�a � . '/n��/1�`, �`-s. City Zip City Zip Describe Proposed Work —! C11� %Yl%��i�%�� v Proiec; Address (if known) Vublic Warks Permit s BItlB�OfiO��X �, �/ / Pu61ie Works Pee S Tat�l Foe Loss ApP� Fea Paitl $ Balence0�o $ . 9�//D Phone Aifaca iour (4) copies of plans for proposed work- Dr2w to scale and note the following as applicable: • Property Lines • Centarline of street • Outline and dimensions of all existing and • Intiicate North proposed structures onthelot • Show any proposed grading change� • Existing and proposed utiliiies • Show measuremenis PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8815. 2. All work shall be pertormed in accordance with this permit ard current City of cverett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•42h-5555. � c�Bc�G G�.�'�s �E,�,��T �rJoT �'EqUi,PE'o Approved for Consiruction Date FINAL INSPECTION Date Approved a& Constructed everett PUBLIC WOFiKS DEPARTMENT � 3e00 Cedar Street Everett, WA 98301 Phone: 259•88: 5 % LZ �q% � �f� ACKNOWLEDGEMENT OF CONDITIONS W � � � O ♦�� V♦ 0 a The undersigned ownr.r/applicanl hereby agrees to hold and save harm- less lhe City ot Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other righPohway use nereto applied tor and luriher agrees to remove same upon notice from ihe City and to replace public property damaged thereby. Signature of Applicant Date WORK AUTfiOR!ZED BY THIS PERMIT MUST BE STARTEU WIl"HIN 180 DAYS OF DATC PERMIT IS ISSUED AND THEREAFTER IS Tv BE DILIGENTLY FURSUED TO COMPLETION. THIS PER�41T MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.