3532 LOMBARD AVE 2016-01-01 MF Import

Date_�� Application For PUBLIC WORKS PERMIT 8v ivf PUCIic WorW Permil • BI09�Da0�.+ �� Puol'mwo�kaFea s ��y,G�v Total fee Lens ApO� Fee Pe�C S Balence �ua S 7�U ' C� G Print or Type Only �9��,6 e....r��m Melling Address City Gip rnune Project Address (if known� v`�'3 Atlach four (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: • Property Lines • Outline and dimensions of all existing and proposed 5tructures on the lot • Exisling and proposed utilities • Centerline ol street • Indicate Nrnth • Show any proposed grading changes • Show measuremenis PERMIT CONDITIONS 7. All calls for inspection shall be made 24 hrs. in advance - phone 25�-881 5. 2. All work shall be performed in accordance with ihis permit and current City ol Everett Design and Construction ctandards and Specifications. 3. Call Lor,aiio�� derground Service 48 hrs. before you dig. TOLL F'REE NUMBER 1-800•424•5555. S '�� Approved for Construction Date �.i� ��-�� -✓=y FINAL INSPECTION Date Approved as Cunsiructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everelf. WA 98201 Phone:259�8815 ACKNOWLEDGEMENT OF CONDITIONS � O The undersigned owner/aUP�icant hereby agrees to hold and save harm� less the City of Everett from any and all claims lor damages. costs. expenses, or causes of action that may arise because of installation and maintenance oi lhe improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice Irom the Ci!y and to replace publir, roperty damaged therPby. .� - - . Signature ot Applican Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARI ED WITHIN 180 DAYS OF DATE PEFMIT I�� ISSUED AND THEREAFTEfi IS TO 8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PqOJECT OVER 50 DAYS DURATION.