1204 PACIFIC AVE 2016-01-01 MF Import

i � ,-� ,.E, i Date � r'�, PubLc Works Per��— Application For BIEq.DepL• � PUBLIC WORKS PERMIT P°°°°W°�k°F°° Tolal Fee s- leea Rpcl Fee PoiC 3 Print or Type Only ea�s��oo�e s yi= l,Er. L„�l'`I-1 �l�Ci F<' _ ��;r��T- �87�! � ^� ner` MailingAddress Ciry Zip Phone r�-1Y11 r: Applicant Mailing Address City Zip Phone t /}� Deacribe Proposed Wo�k �,^�� _ �C I Project Addreas�if known) 1�C_-�L� 1�� . � � Attach four(4)copies of plaris�or proposeC work- Draw to scale and nolc the tollowinp es applicable: � • Property Lines • Ctnterline of street � • Outline and dimensions ot all existing and • Indicaic North propo�eC atructures on the lot • Show any propuatJ greding changes � Existirig end propoced utilities • Show measurements � DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS t. All cells tor inspaction ahall be mede 24 hra in advance-phone 259•8815. � 2. All work ahell be pertormed in accordance wR:�this permit and current C0y ol Everelt Design and Constructfon Standa�de end SpecificaHons. 3. Cell Locetion UndergrounC Service 48 h•s.befo�e you dip.TOLL FREE NUMBEN 1•800•424•5555. � �C,v �.A/J� 2Za� 7—L�- � �� "' ��"r �/� \II O a ACKNOWLED3EMENT OF CONDITIONS The undersigned o�aner/applicant hereby eArees to hold and save harm- less the City of Everett from a�ny and all claims for damegea, cost& expenses, or causes of action Ihat may arise because of Installetion and maintena�ue ot the improvement or other right-of-way use herelo • app�ied for and further agrees to remove same upon notice from the Approved for Construction Date Ciry and to replace public property damaged thereby. FINAL INSPECTION Date Approved as Constructed SignaWre of ApPlicant Date everett PUBLIC WORKS OEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Evere��,WP,98201 BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAl'BE Phone: 259�6815 CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURATION.