4627 GREELY ST 2016-01-01 MF Import

Date ��L11LC\% � � _ Application For PUBLIC WORK� PERMIT Print or Type Only Address Describe Proposed Work Project Address (it known) Attach four (4) copies of plans for proposed work - Drav • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS Zip Zip scale and note the lollowing as applicable: PUEIicWoranPer • � ��`^`� BIEq. DeO� • � Public Woras Fee Totelfae : LeaS Rppl Fep PaiC S n Balance O�e S IQ � • Centerline of sireet • Indicate North • Show any prcposed grading changes • Show measurements BY,G / % �/3-/J .; ,� 1. All calls for inspection shell be made 24 hrs. in advance • phone 259•881 5. 2. AII work shall be performed in acaordance with this permit and current City of Everett Design and Construction Standards and Speci(icationa 3. Call Locetion Underground Service 48 hrs. belore you dig. TOLI FREE NUMBER 1-600�424•5555. `�JC� ��- / ?�3 as- Approved for Construction Oate �--�� -�3 -� FI TION Date Approved as Constructed everett PUBLIC WORKS DEPARTMFNT � 3200 Cedar Street Everett, WA 98201 Phone: 259•8815 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save herm- less the City ol Everett irom any and all claims for damages, cosls, ezpenses, or causes of action that may arise because of instellation and maintenance of the improvement or other right-of-wey use hereto applied for and further agrees to remove same upon notice from ihe City and to replac ublic property damaged thereby. ; •r Signature of pplicant Date WORK AUTHORI2ED Y THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED 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 OVER 90 DAYS DURATION.