2120 RAINIER AVE 2016-01-01 MF Import

� � TYPE OR PRINT ONLY Owner Application For PUBLIC WORKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 259•8810 Address Describe Proposed Work PROJECT ADDRESS (if known) !�D 0 ary � o�e �/ ,�.� � Public Nbrks Permit M 7 Building Permit N Public Works Fee S� e % t �1��a � � Zio Phone Anach 1 our (4) copies of plans for proposed work - Draw to swle and note lhe following ii applicable: •Pn:oerty Lines 'Outline and dimensions of all ezisting and proposed st/uctures on the lot •Existing and pioposed utilities •Centerline oi streel •Indicate NoAh 5how any proposed 9rading changes •Show measurements PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. 2. All work shall be performed in accordance with this pertnit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. �, �1 G� 33�I -7`�03 �r; e� � �oarr��•y v�r�G��-� �'✓ ; �'! srLc i�en . / ACKNOWLEDGEMENT OF CONDIT70NS The undersigned owner/applicant hereby agrees to hold and save harmless the Ciry of Everett from any and all ciaims for damages, costs, expenses, or causes o1 action that may arise because of installatbn and malntenance oi the improvement or other right-ol-way use hereto applled for and tuAMx egrees to remove same upon �otice from the City and to replace public propeity damaged lhereby. Signature o1 Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIhiIN 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY OE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAVS DURATION.