3308 PINE ST 2016-01-01 MF Import

Date1� Applicalion For PUBLIC WORKS PERMIT Print or Type Only C�iy c��v Describe Proposed Work Proiact Address �if known� �-�; �a f � �l�' -� � - Atlach four �4) copies ol plens br proposed work - Draw to scale and note Ihe lollowing as applicable: • Properry Lines • Outline and dimensions ol all e■isting and proposed structures on the lot • Existing and proposed utiGties Pu�ec War�s Pmm�l �� //��7 � G�L= 1/ eino oeoi.. �'Q J_�1��--_ .� Pe�l¢ WorAs Fce iotal Fee S --- Less 4pn� Fne Paid S a �-a=z� Cniance Dur. _ • Centerline ol sireet � Indicate Norih • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection shell be made 24 hrs. in advance • phone 259•8810. 2. All work shall be pertormed in accordence with this permit and current City of Everett Design and Construction Standards and Specificetions. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FPEE NUMBER 1•800-424•5555. �/O D.c'i�v-l�:4y .�CLC��,ED ` �� (n � �jC2'��% G -a� ,`/� Apnrovetl for Cons ruction Date � �,,j S'-/-f� F�N�L INSPECTION Date Apprcved �s ConsL ucted everett PUBLIC WORKS �EPARTMENT � 3200 Ccdar SL :M Everett, WA 9B<01 Phone: 259�BB10 C�FF oF /�iN� STii'_Fi-T— ACKNOWLEDGEMENT OF CONDITIONS W H � � � � O a The undersigned owner/applicant hereby agrees to hold and save harm- tess the City ol Everett from any and all claims for damages, costs. expenses, or causes ol action that may arise because ol installation and maintenance of the improvement or other right-ol•way u5e hereto applied for and further agrees to remove same upon notice irom the City and to replace public property damaged thereby. ' ��,-� i-7-�i Signature ol ApPlicant Date WORK AU7HORIZED BY THIS PERMIT MUST BE START[D WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO BE DILIGENTLV PURSUED TO COMPLET�ON. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.