2426 MADISON ST 2016-01-01 MF Import

Da2e�/�� Application For PUBLIC WORKS PERMIT Print o� Type Only ng Address Desc�ibe Proposed Work Project Address (if known) �- Ciiy PuElic WorY,e Pepim�il • ��/�S /1ro BIEp. DepL ♦ () � /r✓� i PubliC Works Fea Talal F¢a S — — La9s ADG� Fee Paltl S Balance Due S �/�. �� 76 s�/.s� � / , /�, .._ 3ay- Zip r�ione Attach four (4) copies uf plans for proposed work • Draw to scaie and note the (ollowing as applicable: • Property Lines • Centerline of street • Outline and dimensions ot all existing and • Indicate Norih proposed structures on the lot � • Show any proposed grading chanco- • Existing and proposed utilities • Show measurements PERMiT CONDITIONS 1. All calls for inspectio� shall be made 24 hrs. in advance - phone 259•8815. 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction Standerds and Specificatlona 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. 7. To Bc f'o,r/sr.�ic7�'-O �'�,C '1•�•�'•�ov�G� P-eivs G�rrf� FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS 0 � 3200 Cedar Street Everett, WA 98201 Phone: 259�3815 y�-z9-as W H � � � O � � � a �1CKNOWLEDGEMENT OF CONDITIONS The undersigned owner/apP�'cant hereby agrees to hold and save harm- less the City of Everetl from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance ol the improvement or other right-of-way �se hereto applied for and further agrees to remove same upon notice irom the City ana to replace public property dainaged thereby. �//� � �� ° �-//p s- � �>/ ll! Date Sig Iature ol Applicant WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 130 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO �E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E CANCELLED BY THE CITY UPON ANY STOPPAGE OF WC9K ON THIS PROJECT OVER 90 DAYS DURATION.