1405 PINE ST 2016-01-01 MF Import

\ �8te � �� 8s Vublle Wo�b�ermit• O S—SJ i eiac.oso�.• Applicatlon For PUBLIC WORKS PERMIT P�°To;;FeFea , lesa AGG�Fee Pei� S B��anceDue f �� Print or Type Only 7s38'3 tlo�la� /y1 A, �;A �� ecl� 9�i=o� a�1//lo,� Owner Mailing Address City Zip Phone Applicent Mailin/Q�Address City Zip Phone � Deacribe P�oposed Work -----�E�v_c_c�=S�/� ��"—/�. �J� �i�`-y ' •• —_, , 1 M M W H � � �,. � � Pro�ect Address(il known) �'� s irv � Attech four(4)copies of plans(or proposed work-Drav+to scale and note the tollowing as applicable: � y • PropeAy Lines • Centerline ot street � d • Oulline end dimensions ot all existing and • Indicate North y pr000aed strucWres on ihe lot � • Show any proposed grading changes T • Ezisting and proposed utilities • Show measuremenls M ��Q Z DO NOT WRITE BELOW THIS LINE O � � PERMIT CONDITIONS 1. All cells for inspection shell be mede 24 hrs in advance• phone 259•l3815. � p � 2. All work ahell be pertormed in eccordance with this permit and current City of Everett Design and Construction 's� Standa�ds end Specilications � 3� Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � �..� N O � � • � � � O � a � � M � ACHNOWLEDGEMENT OF CONDITIONS The undersig�ed owner/applicant hereby agrees to hold and save harm- less the City ol Everett lrom any and all claims tor damages, costs. expenses, or causes ol action that may arise 6ecause ol instellation ` � and maintenance ol the improvement or other right-ol•way use hereto �!G �-�-� � � �'� applieA lor and further agrees to remove same upon notice from the Approved lor Construct on ate City and t eplace puhlic prop 9'da aped thereby. / -� ��_.�--S 3i �J � - � �.. � � i. i.; FIM INSPECTION Date Date Approved as Constructed Si alu e of A,plicant WO AUTHORIZED BY THIS RMIT MUST BE STARTED WITHIN everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND TfiEREAFTER IS TO � 3200 Cedar Street BE OILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259•8915 PROJECT OVER 90 DAYS DURATION.