1615 HOLBROOK AVE 2016-01-01 MF Import

Date _ _ Application For PUBLIC WORKS PERMIT Print or Type Only Mailing De��ri6e Proposed Work Address City Prolect Address (it known) Attach four (4) copies ot plans for proposed work • Draw to scale and note the lollowing 3s applicable: � property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed ulilities PuEbcWoiksPermilr �� 33 eia¢ oeo�.+.— Pubbc Works Feo S Totel Fee �eas App�. Fne Pa�C S BalanceDue S ��- • Centerlin� of street • Indicate Nor�h � Show any proposed grading changes • Show measurements 3�5 3�, Phone J Phone PERMIT CONDITIONS 1. All calls for inspection shalt be made 24 hrs. in advance - phone 259•8810. 2. All work shall be pertormed in eccordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. Approved for Constructio / / � ��,� .�-I�,�a�'— ( � �"-lf �� r�n e� �ucocrnnni Date Approved as Conslructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Sireet Everett, WA 98201 Phone: 259�BB70 ACKNOWLEDGEMENT OF CONDITIONS � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City ol Everett from any and all claims lor damages, costs, ezpenses, or causes of action ihat may arise because of installalion and maintenance of the improvement or Olher righl•ol-way use hereto applied for and turther agrees to remove same upon notice irom the City and to replace public property damaged thereb�,. � ,C Y�'�� j _ o.,.wtA SigA6 e of Applicant Da�e WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 D�YS DURATION.