604 HAWTHORNE ST 2016-01-01 MF Import

DateJL.s�t�� Application For PUBLIC WORKS PERMIT Print or Type Only owner Zip y �9 -ay-s Pubiic Wode Parpmtl/� �/�`JZ'� Bldp. Oept � 1L�7 /b �� J �u�lic Worke Fae To�el Fee s _ L069 ADP� FBB PBiE S �1 Baiance Due S `O O O S AiYI F� Applicant Mailing Address City Zip Phone Describe Proposed Work QUI� � 'OVT �� Project Address (if known) Attech lour (4) copies ol plans lor preposed work - Draw to scale and note ihe fullowing as applicable: • Property �ines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS • Centedine of street • Indicate Norih • Show any proposed grading changes • Show measurements t. All calls lor inspection shall be made 24 hrs in advance - phone 259•8815. 2. All work shall he performed in accordance with this permit and current City of Everetl Design and Consiruction Startdards and Specifications. 3. Call Location Underground Service 48 hrs. betore ynu diq. TOLL FREE NUMBER 1-800•424•5555. �'�` � /% �4/"_ �d7T�'1� i �b� c� Approved tor C struction ate ��—� //'.r�� 7—/,%'`% '�rAL INSPECTION Date Approved as Constructed evr.rett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everetl, WA 98201 Phone: 259•8815 ACKNOWLEDGEMEN7 JF CONDITIONS W H � � � O � � O a The u�idersigned ownedapplicant hereby agrees to hold and save harm• less the City of Everett frorr� _ny and all claims for damages, cosis, ezpenses, or causes of action that may arise because of installation and maintenance of ihe improvement or other �ight-of-way use hereto applied for and further agrees lo remove same upon rotice Irom the Ciry and to replace public property damaged thereby. r:i'-��C/�" � Signature of Applicant Da�e WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE ?ERMIT IS ISSUED AND THEREAFTER IS TO OE DILIGENTLY PURSUED TO COMi�LETION. THIS PERMIT MAV BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.