4201 GRAND AVE 2016-01-01 MF Import

DateJ3��1'6 Application For PUBLIC WORKS PERMIT Print or Type Only L, Address z+u FubL[ N'oh3 Pe�mi� � BIEB. Dept. s �� % �l �� ruelic works Fae Totel Fee s Less ApO� Fee Paitl s Baiancr Dur S DescribeProposedWork _�� /`P ln� Pr1^� Q,(�N��iriL /a .J�iM9�(� ��L1"!��_ Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • PropeAy Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed struCtures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT COND�TIONS 1. All calls for inspection shall be made 24 hrs. in advance • phona 259•881 5. 2. AP work shall be pertormed in accordance with this permit and current C�ry ol Everett Design and Construction Sl:.ndards and Specifications. 3. Ca�i Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. %�Uvn�ic �o.e.t_s' �E.�ir,�7 ir/OT ,PE9a.,eEO iz� s�/�6 �?� Approved tor Construction Date FINAL �NSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259�8815 ACKNOWLEDGEMENT OF CONDITIONS �J � � O a The undersigned owner/applica�t here6y agrees to hold and save harm- less Ihe City of Everett from any and all claims for damages, costs. expenses, or causes of action that may arise because of instal�ation and mainlenance ol the improvement or other right-ol-way use hereto applied lor and further agrees to remove same upon notice irom the City and to replace public property damaged ihereby. Signature of Applicant � Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ChV THIS PROJECT OVER 90 DAYS DUFiATION.