3811 GRAND AVE 2016-01-01 MF Import

Date T-�o2�-5 Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address `x� 4 Z- Puehc wads PeBr t n• BIAB� DBPL � �(1( Pu�lic Wo�ks Fee s Total Fea Less Roa� Fee Pa�a S Balpncv Due S 2'U � Phone APPlicant A9aiiingnaaress . ��y ��v ��_ Describe Proposed Work np ci >�'��` �—� F� ' 1)P ��I �5 h r'' �� rP.S Prolect Address (if koown) � �� i � � w�• -1 Attach four (4� copie5 ot plan_ lor proposed work - Jraw to scale and note ihe lollowing as applicable: • Property Lines • Outline and dimensions of all ezisting and proposed structures on the lot • Existing and proposed utilities for • Centerline of street • Indicale North • Show any proposed greding changes • Show measurements PERMIT CONOITIONS 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. 2. All work shall be peAormed in accordance with lhis permit and current City of Everett Desig� and Construction Standerds and Specifications. 3. Call Locetion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. FINAL INSPEGTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200CederStreet Everett, WA 98207 Phone:259�8810 Z3 � 9v _ Da�e �. Dale ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigned owneqapplicant hereby agrees to hold and save harm I less the City of Everett irom any and all claims for damages, costs. ', ezpenses, or causes ol action that may arise because of installation � and maintenance ol ihe improvement or other right�of�way use hereto applied for and turther agrees to remove same upon notice from the City and to replace public property damaged thereby. � � �^�° Signature of App ican Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY T�1E CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. �