901 GRAND AVE 2018-01-02 MF Import

Det@1�_a7 qpplicetion For PUBLIC WORKS PERMIT Print or Type Only Applicant Deacribe Proposed Work � ��; L a_ 90/ Grv� Mailing Address �� (�nnc�" 1�0, �� " Maifing Address Prol�t Addresa (if known) �� ItJ ��?^ �1 ,4y Attech lour (4) copies of plens lor proposed work • Draw to scale and note the followin£ as applicable: • PrOperty Lines • Outline end dimenalons of ell exisling and proposed atructures on the lot • Exletinp end proposed utilities ✓ PuElic Wa�ka Pnrmil • V "I �T amo. oap� . 2 Publle Worka Fee s Tol�l Fee Lese RDPL fae P�iE g BalanceDue S �D� • Centerline ef street • Indicate North • Show any proposed grading changes • Show measuremenis Phone Phone PERMIT CONDITIONS �n 1. All cslla for Inspection shall be made 24 hra in advance - phone 259'�. �j�a� 2. All work shall be pertormed In eccordance with lhis permit and current Clty of Everetl Design and Constructlon Standertla and Specificetions 3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. Approvad lor Con lon Date /O —1/—� FINAL INSPECTION Dete Approved ee Conetructed �� PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259iy�i�v $ ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigned ownor/applicent hereby agrees to hold and save harm- less the Cily of Everett Iram any and all claims for demages, coate, expensas, or ceusea of action thet may ar(se because of installelion and maint nce he improvement or other righbot•wey uae he�eto applied r nd��9rees to r�ave s;me upon notice from the Cily a to epl ce u ic propert�a�Aeg� the�eby. 'L�" / «».n��" 6 9 - SI ture of App c nt Date WORK AUTHO IZED BY THIS P RMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISuUEO AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVLR 90 DAYS DURATION.