4942 OCEAN AVE 2016-01-01 MF Import

Oate I 1 �� qpplication For PUBLIC WORKS PERMIT Print or Type Only Owner Mailing Aodress � City Zip Pu01r< Wo�Ms Fetmll • eioe� oeoi. • — PuLlic Worka Fee Total Fee s Lesf Appl. Fee PaiO S 9alanca Oue S —`1� 1-i—Y� AppliCent Mailiny 4ddress Clty Zip Phone DeScribe Proposed Work L—Y't-/<GTL`-�� Project Adtlress lif known) Attach four (4) copies of plans for proposed work - Oraw to scale and note the followinq as applicable: • Property Lines • Centerline ot street • Outline ar�d dimensions of all ezisting and • Indicate North proposed structures on the Iot • Show any pro{�osed grading changes • Existing antl proposed utililies • Show measurements PERMIT CONDITIONS 1. All calls tor inspectian shall be made 24 hrs. in advance • phone 259•8810. 2. All work shall be pertormed in accordance with this permit and current City ol Everett Design and Construction Stenderds end Specifications. 3. Cnll Location UndorgrounA Service 48 hrs. before you dig. TOLL FREE NUMBER 7-800•424•5555. . � /' ��0 �� 2 , /QS � �/�� `'� ' -��z� �'�! �� a-�-�-� ��, ,(�.-� �' � ` /� � /�s�S� io2��'�^^"`�t"Cl 7J 7L/�..�� ., (/ � � , ACKNOWLEDGEMENT OF �ONDITIONS Approved for Construction Date FINAL INSPECTtON Date Approved as Cons��ucted eveiett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98207 Phone: 259�BB70 W F- � � O � � O a The undersigned owner/applicant hereby agrees ro hold and save harm• Ie55 the City of Everelt irom any and all claims lor tlamages, Costs, expenses, or causes oi action that may arise because of installation and maintena�ce of ihe improvement or other right-of•way usc hereto applied lor and further agrees to remove same upon notice irom ihe Cily and to replace public property damaged thereby. Siqnatwe of Applicant l7ate WORh AUTHOFIZED 8Y THIS PERMIT MUST BE STARTED �YITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.