421 MADISON ST 2016-01-01 MF Import

Date�% t .5; -'.. t.�.'. ...�.y.. '. � ' �'6"�ti�},)2sf 1 �.ri` x �,: i^+ a� �p . ,. a: .:.,�.�.�i�r,..0 , p'..'. .. Application For PUBLIC WORK� PERMIT Print or Type Only r Applicant Descri6e Proposed Work P�olect Address (if rtnown) Mailing Address Mailing City ; _. . Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing antl proposed struclures on the lot • Existing and proposed utilities PEaM1T CONDITIONS Puelic Wo�ks Permn n BItlO. �epl. s � 7�/ VuEOc Works Fee S To:alFee Less Appl. Fee Paitl g Balance Oue $ rnone 2�/r i0 S-7i uZS/ Z Phon� • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements t. All calls for inspection chall be made 24 hrs. in advance - phone 259-881 5. 2. All work shall be pertormed in acc.irdance with this permit and current City of Everett Design and Conslruction Slandards and Specifications. 3. Cail Location Underc�round Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. Approved for Cunstruction Date FINAL INSPEC710N Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Streel Everett, �NA 98201 Phane:259-8815 DGEMENT OF CONDITIONS I— � w _ / O a �licant hereby agrees to hold and save t�arm- less the City of Everett from any and all claims tor damages, costs, expenses, or causes of actior, that may arise because of installation and maintenance ot the improvement or other right�of�way use nereto applied for and further agrees to remove same upon notice from Ihe City and to repl�ce public property damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS D�RATION.