1813 MADISON ST 2016-01-01 MF Import

Date�LL�1C,� ^ � � Application For PUBLIC WORKS PERMIT Print or Type Only �, D 6 Mailing Address r Fu�lic Works Gor 1 • pl�p. Dept. a �y5� Puelic wo�xs Foo � iolai Fee Less ApO�� Foe Pnia $ Balance oue $ �.�3- �"a%,� Phone _ � �A ht �_- -- Applicant Mailing Address City Zip Phor,e Describe Proposed Work I `o � �� "�� 0 �v �r �5�1� � � `v��C ��T %� Prolect Address (if known) Atlach four (4) copies of plans tor proposed work - Draw to scale and no�e the following as applicable: • Propr.rty Lines • Centerline of street • Outline and dimensions o( all exis�ing and • Indicate North proposed structures on the lot • Show any proposed grading changes f Existing and proposed utili�ies • Show measurements PERMIT CONDITIONS 7. All calls for inspection shall be made 24 hrs. in ��dvance - phone 259•881 5. 2. All work shall be performed in accordance with 1 iis permit and current City of Everett Design and Consiruction Standards and Specification�. 3. Sall Location Underground Service 48 hrs. betore you di9. TOLL FREE NUMBER 1•800•424-5555. /j�Q �'c��iC G�2i,'l_r f r��i�rT /1 �qc �..��l� ��, /� /�s Approvad for Construction ACKNOWLEDGEMENT OF CONDITIONS W F- � � O � N O a The undersigned owner/applicant hereby agrees to hold and save harm- less the Ciry ol Everett Irom any and all claims for damages, costs. expenses, or causes of action �hat may arise because of installation and maintenance of thn improvement or other righFol-way use hereto applied for and further agrees io remove same upon notice hom thn Date City and to replace public property damaged ihereby. FINAL INSPECTION Date Approved as Cons�ructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Evere.tt, WA 98207 Hhone:259-8815 Si9nature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENT�Y PURSUED TO COMFLETION. THIS PERMIT MAY BE CANCELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PHOJECT OVER 90 UAYS DURATION.