1110 POPLAR ST 2018-01-01 MF Import

Date.�1{(�4 � Application For PUBLIC WORKS PERMIT Print or Type 1..��Y �730 na Address Maili�g Address Describe Propcsed Work � PUEIic Wo�ka Permli �p�p eiao. onc�.• Q �G � / PuDI1cWo�bfee s Totel Fea Less Aoo� Fee Pa�tl S Balance�ue S �.Pan / 339- �aa G. Ciry Zip Phone �� ,�s ds9-�y�� � � �� Phone Project Address (it known) Atlach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions ol all exisling and proposed st�uclures on the lot • Existing and proposed utilities � �s� • Centerline ol sireet • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction Standerds and Spccifications 3. Call Locetion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-BOO•424-5555. ND �/� ,�� ,��i�� Approved lor Consiruction Date FINAL INSPECTION Date Approved as Constructnd everett PUALIC WORKS DEPARTMENT � 3200 Cedar Street Everell. N'A 98207 Phone: 259�8875 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � � a Thr. undersigned owner/applicant hereby agrees to hold anA save harm• less the City ol Everelt irom any and all claims for damages, costs, expenses, or causes of a�:tion that may arise because of inslallation and maintenance ol lhe improveinent or other righl�ol�way use hereto applied for and further a�rees to remove same upon notice Irom the City and to replace public property damag�d thereby. Signature ol Applicant Dale 1NORK AUTHORIZED BY THIS 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 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DHYS DURATION.