1028 LOMBARD AVE 2016-01-01 MF Import

'/^, �� Publlc Wods Permit r �a^ � Date � � gldg DepL• 9J 7 Application For PUBLIC WORKS PERMIT PuOTotalFeeFee s Less AOo��Feu Paid s Balance Due S Print or Type Only �t,1�Cl��,i �i�u�«,;� /n �L�l lln�r�li�ni,�� //,�C' C_.,[lG2L,�i ��Z�� 9'i?-�.�9� Owner Mai4ing Address Crty Zip Phone "`"�- ' " CitY Zip Phone Applicant Mailing Address Describe Proposed Work � project Address(if known) � � Atlach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � � property Lines • Centerline of street � Indicate North • Outline and dimensions of all ezisting and � Show any proposed grading changes proposed structures ori the lot � Show measurements M • Existing and proposed utilities W —� DO NOT WRITE BELOW THIS LINE � PERMIT CONDITIONS � 1.All calls for inspection shall be made 2A hrs.in advance-phone 259•8810. 2.All work shell be performed in accordance with this permit and current Cily of Everett Design and Construction Standards and Specifications. � 3.Cal�Location Underground Service 46 hrs.before you dig.TOLL FREE NUMBER 1-800'42455 . O /V v 1�U.h-� tv�az� Pe-=-"'=-��vc''`-i'`-Y' I,.., v � � 9 �/9 z Q a ACKNOWLEDGEM[NT OF CONDITIONS "fhe undersigned ownedapplicant hereby agrees to hold and cave harm- less the City of Everett from any and all claims for damages, costs, — expenses, or causes of action that may arise because of installation and maintenance of lhe improvement or other right-of-way use hereto applied tor and further agrees to remove same upon notice irom the qpproved for Construction Date City and to replace public property damaged th=reby. Dale Date FINAL INSPECT�ON Signature o(Applicant Approved as Constructed yypRK AUTHORI'LED BY THIS PERMIT MUST BE STARTED WITHIN PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PEfiM1T IS ISSUED AND THEREAFTER IS TO /�rl� 3200 Cedar Street CANCEILLEDTBY THE C TY UPONOANY STOP AGEIOF WORK ON THIS Everett,NA 98201 � Phone:259-8810 PROJECT OVER 90 DAYS DURATION.