1220 GRAND AVE 2016-01-01 MF Import

Date�(.LL,[.�Q \ ` PuEhc Workt Permit• � � �� / 9 7� Applicetion For Biap Deo�.• PUBLIC WORKS PEE�MIT PuoTotelFeeFee s Lese Aoo�Fee Paia s Print or Type Only BelancaDue f � �[.P�e�" J�n G�,hn� �r Q.. E�.oieff �'—�p� Owner MaiNng Address City Zip Phone SA w�� Applicant Mailing Address City Zip Phone Describe Proposed Work l�(j�(� �7��M 1 C Pro)ect Address(if known) � � Attech four(4)copies ot plans for proposed work• Draw to scale and note the f�llowing as applicable: � • Property Lines • Centerline of street � • Outline and dimensions of all existing and � Indir.ale Norih proposed struclures on the lot • Show any proposed grading changes • Existing and proposed utilities � Show measurements � DO NOT WRITE BELOW THIS LINE � PERMIT CONDITIONS t.All calla for Inspectlon shall be mede 24 hrs.in edvance-phone 259•8810. � 2.All work ahall be performed in eccordance with ihis permit and curtent City of Everett Design and Construction Stendarda and Speciiicetiona 3.Call Location Underpround Service 48 hrs,before you dig.TOLL FREE NUMBER 1-800-424•5555. � �UBLI< L�J�/c� .a��iiT ^/oi ,P�v�2�a ,3��/�g O � � � a ACKNOWLEDGEMENT OF CONDITIONS The underslgned owne�/applicant hereby agrees to hold and save harm• less the City of Everett irom any and all claims for demages, cosla expenses, or causes of action that may a�ise because ol inslallation and maintenance of the improvement or other righi-of•way use hereto Approvatl for Construction Date apvlied for and lurther agrees to remove same upon notice from the City and to replace public property damaged thereby, FINAL INSPECTION Date Approved as Conatructed Signature ol Applicant Dale everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � ��C��s�� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Everott,WA88201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Phone:25&8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.