1215 MADRONA AVE 2016-01-01 MF Import

Datei.Llc�.c�� Applicalion For PUBLIC WORKS P�RMIT F'rint or Type Only FuLLc Wo�ks Pc�md + eiae. oeai. + 9 �— Pu011c Worke Fea 5 -- Talal Fee Lesa AOP�� Fea Peia 5 Belance Due � — Describe Proposed Work Proiecc Address (il known) ' -� Attach lour (A) copies of plans for proposed work - Draw lo scale and nole� CQ^�;e�ine o� y�peyi; ahlr.: • Properry Lines - • indicate North • Outline and Gimensions of all ezisting and � Snow any prol osed grading changes proposed structures on the lot � Show measurements • Exisling antl prc,;osed utilitios PERM�T CONDITIONS i. :�P calls lor inspection sha11 ba made 24 hrs. in advance • Fhano 25�-881 5. 2. All work shall be performed in accordar�ce with Ihis permit and current Ciry ot Everelt Design and Construcifon Standards and Specitications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL PREE NUMBER 1-$00•424•55 . �G/.8G/G Gc90.PiCS /�E•E'i77/T �(/OT �`jEGjU/f��1� � _�"7 � ��Y Approved for Gonstruction �ate FINAL INSPECTION Date qpproved as Constructed everett PUBLIC WORKS DEPARTMEIJT � 3200 Cedar Slreet Everelt, WA 98201 � Phone:259�8�15 W H � � � O � � � a AGKNOWLEDGEMENT OF CONDITIONS The undersigned ownr:dapplicant hereoy agrees lo hold and save harm• less the Gly of Everett from any and all claims br damages, costs, ezpenses, or causes ot action lhal may arise because ot installation and maintenance of the imprevement or other righl�of�way use hereto applied for ar,d turther ayrees lo remove same upon notice Imm the City and to raplace public property damaged lhereby. Date Signature of A,^-P�icanl WORK AUTHORIZED BY THIS PEfiM1T MUST BE STARTED WIT1'.IN 180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFT'cR IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY Ti-IE CITY UPON AIJY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIGN.