421 MADISON ST 2016-01-01 MF Import

Date � 1 7 Application For PUBLIC WORKS PERMIT Print or Type Only I�(/� � Applicant Descrihe Proposed Work Project Address (if known) � . .M �::..f.::.-. City Lip � Attach tour (4) copies oF plans for proposed work • Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Exi;ting and proposed utilities PERMIT CONDITIONS Pu�lic Works Permit1< Bid9.DePts�i1 , d�� — Publit Wcrks Foo Total Fae 5 LC55 AppL FeB Paid S Baience Duo S • Centerline of street • Indicale Nor!h • Show any proposed grading changes • Show measurements 1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259-881 5. 2. All work shall oe perlormed in accordance with this permit and current Ciry of Everett Design and Construction StandarAs and Specilications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. PG��'L%G G��'.CS Approved for Consiruction /��i 'i ,n// /l/OT Ki= ��U/.PEZ� FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259�8815 ;�' /2-87 `?),�'��; ACKNONlLEDGEMENT OF CONDITIONS W � � � O `�A V+ � a The undersigned owner/applicant hereby agrees to hold and save harm- less the City ot Everett from any and all claims for damages, cosis, ezpenses, o� causes of action that may arise because of installation and mamtenance of the improvement or other right-ot-way use hcreto applied for and further agrees to remove same upoo notice from the City and to replace public property damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PEFM17IT MUST BE STARTED W!THIN 180 DAYS OF DATE PERMIT IS ISSUED AND THGREAFTER IS TO BE DILIGENTLY PUR,iUED TO COMPLETION. THIS PEflM:T MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS FROJECT OVER 90 DAYS DURATION.