1823 RAINIER AVE 2016-01-01 MF Import

Date�� Applicetion For PUBLIC WORKS PERMIT Print or Type Only _i1C�h Deacribe Propased Work City Zip Pu01ic Wo�k4 Permi� • `� �—.J �� BIC9. DeVt. � �J�� %/1 � PUEIic Worka Fee To1al Fee S Lesa AOG� Fae PaiE S Balanca0ue S �� Pro�ect Address (if known) �S� Z� —�%f/NF�/1 Al�� _ Attach lour (4) copies of plens for proposed work - Draw to scale and note the following as applicable: • ?roperty Lines . • Centerline of street • Outllne end dimensiona ot all ezisting and • Indicate North proposed structures on the lot • Show any proposed greding chenges • Ezisttng and proposed utililies • Show meesurements Phone PERMIT CONDITIONS 1. hl� calls for Inspectlon shall be made 24 h�s in advance • phone 259-A815. 2. All work shall be performed in accordance with this permil and current City of Evcrett Design and Construction Standerds and Specifications 3. Call Locatfon Underground Service 40 hrs. before you dig. TOLL FREE NUMBER 1•800�424-5555. s��'ov�� a Approved for Cons i ' ate FINAL INSPECTION —� ` ate Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOWLEDGEMENT OF CONDITIONS W � � � O � � O a The undersigned owner/applicant hereby agrees to hold end sava herm- less the City of Everett irom any and all cteims for demeges, costs, expenses, or causes of action thet may arise because of instellation and maintenance of the improvement or other right•of•way use hereto applied for and further agrees to remove same upon notice from the City and to replace public propeAy demeged thereby. ��r 9-�-�i Signature of Applicant Date WORK 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 TH[ CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 9� DAYS DURATION.