909 PINE ST 2016-01-01 MF Import

C - /?-�9-s Date�� Applicetion For PUBLIC WORKS PERMIT Print or Type Only AddreSs Address Describe Proposed Work Project Adtlress �if known� Pu04c Woika Perm�t • 6'A- 3q3 g Blep Deo�. � �J z/y'l� � —�� Publ¢ \Yorks Fee Totel Feo S lev AO�� Fee PaiO S .Balence0ue S �� �� y.Z /,7/ '.�" 2/S/�° l�d' zo � �s 3- y� sr CitY 2iP � Phone �1'c--"�� 3S�-S��S� �h' ZiP Phone� �� ,.� e p T�- �' Attach four (4) copies �f plans for proposed work • Draw to sca�e and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures onihelot • Show any proposeA grading changes � Existing and proposed ulilities • Show meas�remenls PERMIT CONDITIONS i. All calls tor inspectton shall be made 24 hrs. in advance • phone 259•8810. 2. All work ahall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call location Underground Service 48 hrs. hefore you dig. TOLL FREE NUMBER 1-800�424-5555. .� --- �� FINAL INSPECTION Approved as Constructed everelt PUBLIC WORKS DEPARTMENT � 3200 Cedar Street E�rerett, WA 98201 Phone:259•8810 4�-el � � �j' Date ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � � a The undersigned owner/applicant hereby agiees to hold and save harm- less ihe Clty ol Everett from any and all claims for damages, costs, nxpen5es, or causes of action Ihat may arise Decause ol installation and maintenance of the improvement or other rignl�ol-way use hereto applied lor and lurther a9rees to remove same upon notice irom the City and lo replace public property damaged thereby. /� / /�` l !!'`G�! l-�`d�-(i l^�%"�� Signature of Applicant Date WORK AUTHORIZED THIS PERMIT MUST BE STARTEO WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MnY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.