717 GRAND AVE 2016-01-01 MF Import

� � 'V � � �� �� 9�R y�� Rf O �3 �� Q�yr Z> M C" y M WH �� O � � Date�.3 � qpphcation For PUBLIC WORKS PERMIT Print or Tyoe Only �;�� � �� VUE�m Wa�ka Pe�mll r Bioo oeot • p � 7 PuN¢ Worb fee s _ Totel Fee Leif RpO�� f ee Putl S 2ip 0alence Dun 9 ��/ 2�-�- 7� Ci�y Zip Phone ApplicaM Mailing Address Descri� a Proposed Work �� 7 V/� 7'7/l� - Project Address (if knownl — AttacA fou� (4) copies of p:ans lor proposed work - D�aw to scale nnd note� CenlleW�ne ol st�eetcn6le: • Pwparry Lines • Indicale Norlh • Outlino and dimensions ol all er��sling and � Shuw any pwPosed grading changes proposed struclures on the lot � Show mensuremenls • Existiny and proposed utilities �I PERMIT CONDITIONS C� 1, All cells lor inspection s�nll be rnade 2< hrs in edvance�iPand corre� �BtYo� Everelt Design end Construdlon 2. All work shall be performad ln eccordance wilh this pe i Standards and Specilica�ions. 3. Call Location Underprountl Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800'424•5 . ( -zi /7y Y/L[�7��«�z;�� �cJly(=u'. Co�u sj— z,ru-. ,� ADP�a�ed �or Construction Date Date FINAL INSPECTION qpproved as Constructed �PUBLICWORKSDEPARTNENT 3200 Cedar Strect Evere�t. WA 98201 phane:259�8810 G ./t� -�/ W � � � � O � � � a ACKNOWLEDGEMENT OF CONDITIONS The undersigned ^wner/applicanl hereby agrees lo hold and save harm• less the City of Everett Irom any anA nll claims br damages, costs. expenses. or causes ot aclion that niay arise because o� instellation antl main�.enance ol the improvemenl or oi�er righPohway use hereto applied lor .ind lurther agrees to remove same upon notice lrom the Ciry and to repiace public pwperry damaged iheroby. Date Si9nature ol APplicam BORD VSTOFRDAEE PERMIT SESSUED ANDB HEREAFTER ISHTO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S PROJECT OVER 9Q DAYS DURATION.