1409 RAINIER AVE 2016-01-01 MF Import

�� � TYPE OR PRINT ONLY Describe Proposed Work Application For PUBLIC WORKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everetl, WA 98201 259•8810 �!� pQSTING ,�''" ° 9 �' PROJECT ADDRESS (if known) �i�� 9 - �c „y� Date_ J/�//n '� Public Works permit A _ / �ri�� %� Building permit p Public Works Fee $ ao �� BK �^r"i�. � r�, . _ -�� Phone Attach four (4) copies of plans for pioposed work - Draw to scale and note the following if applicable: •Property L(nes 'Outline and dimensions ol all ex(sting and proposed structures on the lot •Exisling and proposed utilities 'Centerline of street •Intlicate North 'Show any proposed grading changes •Show measurements -----.......��+r�v�• iiuJL11VC PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. 2. All work shall be pertormed in accordance with this permit and curcent City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. ^MM'�+�� as l.onStNctEtl Ob/1B/96 / 1100096176 �THER GRSH 3:49FM 520,00 320.00 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agraes to holtl and save harmless the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of•way use hereto applied for and further agrees to remove same upon nolice fmm the City and to replace public property damaged thereby. /� a G�-��-y� v / �.�-nu u ��`<�da-+�.,p..� �—`�� Signature of Applicant D t ae WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHItJ 180 DAYS OF DATE PERMIT IS ISSUED AND hIEREAFTER IS TO BE Lill(.:ENTLY PURSUED TO COMPLEIION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURAiION.