607 OLYMPIC BLVD 2016-01-01 MF Import

Date� � ApplicatiDn For PUBLIC WORKS PERMIT Print or Type Oniy Owner Describe Proposed Work , v +` �� Project Adtlress (if known) ' e�eA�n fn��r 141 cooie5 01 Pians lo� proposed work - Draw to scale and note the tollowing as applicable: • PropertY Lines • Outline and dimensions of all existing and proposed struclures on the lot • Existing and proposed utilities Fu�i�c Worhs Pacrm�I "f Biep. oeo�� • U Pultl¢ Works Fee S io1a1 Fee �rss Appl. Fae PniO S Balance Due i • Centerline of street • Indicate Nor�h • Show any proposed grading changes • Show measuremenis Phone PERMIT CONDITIONS 1. All cells for inspection shall be made 24 hrs. in advance • phone 259-881 O. 2. AI� work shell be performed in eccordance with this permit and current City of E�-erett Design and Construction Stendards and Spectlicatlons. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. �� U � �� Approved for Consiruction Dale FINAL INSPECTION Approved as Consiructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett. WA 98201 Phone:259�8870 Date C��.:� d -�'7-a 8 ACKNOWLEDGEMENT OF CONDITIONS W H � � � 0 H � � a The undersigned owner/applicant hereby agrees to hold and save harm- less the Ci�y ol Everett Irom any and all claims for damages, costs. expenses, or causes ol action ihat may arise because of installation and maintenanre ol ihe improvement or o�her right-of-way use hereto applied lor and further agrees to remove same upon notice trom the Ciry and to replace public properry damaged thereby. Signatwe ol APplicant Date WORK AUTtiORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.