826 OLYMPIC BLVD 2016-01-01 MF Import

� G i Y.P� � 1S .a9-� � Date�.� � �i APPlica'Jun For PUBLIC WOf�KS PERMIT � Print or Type Only Pepl��c Worka Permii � v J /�� 81ap.1!eo�� • Puelk Worke Fee s Tolsl Fee Loss AoO� Fee PeiC � BalanceDue � �� «Q�« 1( If `� Applicant Maiiing Address City Zip Phone Describe Proposed Work r Pro�ect Address (if krown) . '".- " — Attach four (4) copies of plens for preposed work • Draw to scele and note the following as applicable: • Property Lines � Outline and dimenslons of ell existing and proposed structures on the lot • Ezisting end proposed utilities • Centerline of street • Indicate North • Show any proposed grading chenges • Show measurements PERMIT CONDITIONS 1. ATI calis lor inspection shell be made 24 hra in advance - phone 259-8815. . 2, All work shall be partormed in accordance with this F-ermit and current Ciry`oPEverelt Design and Construction Stand@rds e�d °pecificetions. 3. Cell Lecation Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•500-424•5555. �c�� ,, O•F• iCe2 ` �� _�� Approve�onstruction � Date � ��_�G-/-�/� FINAL INSPECTION Dale Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 32G0 Ceder Street Everett, WA 98�201 Phone: 259-8A15 ACKNOWLEDGEMENT OF CONDITIONS W H � � � � � � O a The undersigned owner/applicanl hereby agrees to hold and save herm- less ihe Ciry of Everett from any and all claims for damages, costs, expenses, or causes of ection that mey arise because ot installetion and maintenence of the improvement or other right-of•way use hereto applied for and further agrees to remove same upon notice from the City and �o replace public property damaged thereby. Signature ol Applicant � Dale WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI"HIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERM'T MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJEC? OVER 90 DAYS DURATION. � � H H H �+7 N� � �y� M �Z � N � � �N � . � � � � � Hn M