2616 HILLSIDE LN 2016-01-01 MF Import

Date µ � � Application For PUBLIC WORKS PERM[T Print or Type Only Owner Applicant Describe Proposed Work Project Address (if known) Mailing Address � Public Works Permil e �/ �� [�_ eieo. oac�.• P��ucWorkaFee �7� Toiel Fea � Lesa PoO� Fee Pa�d � Balance Dua f .� ��cf5�2c75 3Ss Zip Phone !c7�' �63-91fS Zip Phone Attach four (4) copies of plans tor proposed work - Draw to scale and note the following as appiicable: • Property Lines � Outline and dimensions of all ezisting and proDosed slruclures on Ihe Iot • Existing and proposed utilities PERMIT CONDITIONS � Cenlerline oi street � Indicate Norih • Show any proposed grading changes • Show measurements t. All calls for inspection shall be made 24 hrs. in advance � nhone 259•881 5. 2. All work shall be perlormed in accordance with this permit and current City ol Everett Design and Construction Standards and Specitications. 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Ceder Streel Everett, WA 98201 Phone: 259•8B7 5 ACKNOWIEDGEMENT OF CONDITIONS W F- � � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of inslallation ��5-- m6 and maintenance ol ihe improvement or other righhof•way use hereto � applied lor and further agrees to remove same upon notice from the a�e Cily and to replace public property damaged thereby. � -/5=� ��o-�.a.-� fi'.�.�, �lL.�. 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 D�LIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE CANCELLED BY THF CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 OAYS DURATION.