1926 RAINIER AVE 2016-01-01 MF Import

Date��3 Application For PUBLIC WORKS PERMIT Print or Type Only Owner ng « City Z�P Public Works Permit s � �/ a�da oep� . 3 a oz, Public Works Fee S�7 � Q[j Totel Fea Less ApP� Fee PaiC S � Belance Due S � �' O � � �f i �9 �.�.� - �z o �t��.er Applicant Mailing Address Ciry Zip Phone Descri6e Proposed Work -n��r�� CR� �� Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to sca�e and note the following as applicable: • Property Lines � Canterline of street � Outline and dimensions of aii existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing end proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls tor insGeclion shall ��e made 24 Yra in advance - phone 259•881 5. 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Conslruction Standards and Specifications. 3. Cell location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. � �6 �l Y� ^'� /O. a7- a.1/P` �I'tGP �BTn.. 7�P4'� / A�d fo— r C�lru�on � Uate �'i �'��i -1- J/ FINA ECTION 'a�e Approved as Conslructed everett PUBLIC WORKS OEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259•8815 �— ACKNOWIEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigned owner/applicant hereby aa�ees to hold and save harm- less the Ciry of Everett irom any and all claims for damages, cosls, ezpenses, or causes of action that may arise because ol installation and mainlenance nf the improvement or other right•ol-way use herelo applied tor and further agrees to remove same upon notice from the City and to replace public property damaged thereby. icinaWre Applican Date WOP.K 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 THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUFATION.