617 OLYMPIC BLVD 2016-01-01 MF Import

Date��`� f --. Application For PUBLIC WARKS PERMIT Print or Type Only Applicant Describe Proposed Work - � �� n�v Prolect Address (if known) Attach four (4) copies of plans tor proposed work •:raw lo • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS Puhlit WOrFs Permi� � _ �' _ �' • BIdA� Dept � _ Pu�1ic Work9 Fca $ Tolol Fea LC59 Fppl Fp0 Pd10 `$ Balance Due S .('�_1��.� C� City Zip 1 C ' .i ._ ity Zip and note the lollowing as applicable: . • Centerline oi sVeet • Indicate North • Show any proposed grading changes • Show measurements Phone 1. All ca�ls for inspection shal� be made 24 hrs. in advance • phone 259•8815. 2. All work shall be peAormed in accordance wilh this permit and current City of Everett Design and Construction Standerds and Specifications. 3. Call Location Underground Service 48 lirs. before you dig. TOLL FREE NUMBER 1•800-424•5555. �� ,��,�-s j�=,�u�:�,r ��,r ��r��,�-�Fo G-/-r�7 Approved lor Construction Datc FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Ce�ar Street EveretL WA 98201 Phone:259�8815 Date ACKNOWLEDGEMENT OF CONDITIONS W H � � O � � � a Thc undersigned owner/applicant hereby agrees to hold and save harm- less Ihe City of Everett trorn aoy and all claims ior damages, costs, expenses, or causes ot action that may arise because of installation and maintenance of Ihe improvemenl or other right-ohway use hereto applied lor and furlher agrees to remove same upon notice trom the City and to replace public property damaged thereby. Signaturc of ApPlicant Date WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETICN. THIS PERMIT MAY BE C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJ[CT OVER 90 DAYS DURATION.