4204 OLIVE ST 2016-01-01 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Describe Proposed Work Project Address (if known) Atldress naaress Ciry � Pu01¢ Woiks Porm�9 • -- 7�� emp oeo�. + _T_' PublicWoikgpeo s Tolal Feo Less Rppl. Fee Paid S 9alenre Oue S � -�I' Z�P Phone Ci�y Zip Phone Attach four (4) copies of plans for proposed woik - Draw to scale and note Ihe lollowing as applicabie: • Property Lines • Outline and dimensions of all existing and proposetl structures on the lot • [xisting and proposed utilities • Centerline oi street • Indicate North • Snow any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for insnection shall be made 24 hrs. in advance- phone 259•8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specitications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. for Consiruc�ion 12d� ��r'2�p ��2/ ��a Date FINAL INSPECTION Date Approved as Constructe' everett PUBLIC WORKS D[PARTMENT � 3200 Cedar Street Everetl, WA 9A207 Phone:759-R810 ACKNOWLEDGEMENT OF CONDITIONS W � � � � 0 H � � a The undersigned owner/applicant hereby agrees to hold and save harm- less ihe City of Everetl Irom any and all cla�ms lor damages. costs, expenses. or causes ol action Ihat may a�ise because ol installation and maintenance of the improvement or other right-ohway use here�o anPlied lor and further agrees to �emove same upon notice I�om �he Ci;y and to replace pubhc proncrly Camayed Ihereby. Signature o� AppGr,ant Date WORK AUTHOR12C-D BY THIS PERAIIT MUST BE STARTED WITHIN 180 DAYS OF UATE PC-RMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLV PURSUED 10 COMFI.EiION. THIS PERMIT MAY BE CANCELLED BY THf_ CITY UPGN �NY STOPPAGE OF WORK ON THIS PROJECT OVCR ?0 DAYS DURI�TION.