907 PINE ST 2016-01-01 MF Import

Date�p{�� Application For PUBLIC WORKS PERMIT Print or Type Only 2G'% Describe Proposed Work Project Adtlress (if known) ✓ PUEIrc WorMa Parmit s ✓� �7�v o�ae oen�.: �� !i Z nl J Pu�lit Worka Fea Totxl Fea S less pppL Fae PaiU S �D� Balnnce Due S •� Attach lour (4) copies of plans for proposed work • Draw to scale and note Ihe foilowing as applicable: • Property Lines • Centedine of 5treet • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show maasurements f".� /3/ Uu ,�' � /S/ o0 PEiiM1T CONDITIONS 1. All calls for Inspection shell be made 24 hrs. in advance • phone 259-8810. 2. All work shall be perlormed in accordance with t�is permit and current City ol Everett Design and Construction Standards end Specifications. 3. Cell Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. C=%�'�K/!/✓ �%�XJ�'' U /�/O Approved lor C nstructi j Date ��v 6-.r � -f� FINAL INSPECTION D'ate Approved as Constructed everett PU�LIC WORKS DEPARTMENT � 3200 Cedar Slreet Everett, WA 9820t Phone:259�BB10 ACKNOWLED�EMENT OF CONDITIONS W H � � O � � O a The undersigned owner/ap�licant hereby agrees to hold and save harm- less the City ol Everett irom any and all claims for damages, costs, ezpenses, or causes of action that may arise because ol installation and maintenance ol the improvement or other right-of-way use hereto applied lor and further agrees lo remove same upon notice Irom the City and to replace public properry damaged thereby. � �Q � �,/ �'"U O d!� .Zi ' � � � / Signature of Applicant Date WORK AUTHORIZED BY IS PERMIT MUST BE STARTED WITHIN 180 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 WOFiK ON THIS PROJECT OVER 90 DAYS DURATION.