2108 GRAND AVE 2016-01-01 MF Import

"i , 1 � , Date'L�� 1 r� ."^� PUULCWOrkSPe��[W��-1 �I�,q.( Appliwu..•n For Binq ocpi.+ �{_ �' ��_� PUBLIC WORKS PERMIT PubTo�FeeFee S -_- LC55 Rppl F¢P PqiC `S Bala�ce Due S Print or Type Only 1,�5-�'Yl!Y )11_.�- - Owner Mailmg Address City Zip Phone � Applicant Mailing Address City Zip Phone i Describe Proposed Work ��1 I W Proied Address lif known) . � Attach four�4) copies of plans for proposed work- Draw to scale and note thr_ lollowing as aoplicable: � • Property Lines • Centerline of street � • Outline and dimens�ons o1 all ex�sUng and • Indicate North proposetl structures on the lot • Show any proposed grading changes • Existing and proposed utillties • Show measurements � DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1.All cells tor inspection shall be made:4 hrs.in advance-phone 259•8810. � 2.All work shall be peAormed in accordance 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 7•800�424•5555. � �� 9 � Q <�� " _ �o - � � � �� N O a ACKNOWLEDGEMENT OF CONDITIONS � The undersigned owner/applicant hereby agrees to hold and save harm- - less the Ciry ol Everetl Irom any and all cla+ms for damages, wsts. ezpenses, or causes of action that may arise because of installation and maintenance of the improvement �r other right•of-way use hereto applied for and turther agrees to remove same upon no�ice irom the i Approved for Construction Oate City and to replace public property damaged thereby. . FINAI INSPECTION �� I qpproved as Consiructed Signature of Applicant Dale , WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED b'JITHIN � everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO , � 3200CederSireet BE DILIGENTLY PURSUED 70 COMPLETION.THIS PERMIT MAY BE Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS Phone:259-BB10 PROJECT OVER 90 DAYS DURATION. I � � I