3312 NASSAU ST 2016-01-01 MF Import

� ite.�p=� ! r-. Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Mailing Address Describe Proposed Work � ti--� � `� `� P�oject Address (if known) City �. IPublie Works 14rm�_� Blda. Dept. • Zip Ciry Zip Attach four (4) copies of plans for proposed work • Draw to scale and note the lollowing as applicable: • Property Lines • Outline and dimensions of all existing and proposed siructures on the lot • Exfsting and proposed utilities FF.RMIT CONDITIONS vuelic works Fae Tolel Fea S — Lase AppL Fee Paltl S Belonce Due S . � Centoiline ol streel • Indicate North � Show any proposed grading changes • Show measurements 1. All cells for inspection shall be made 24 hrs in advance • phone 259-8815. 2. All work shall be performed in accordance with this permil and current Ciry of Everetl Design and Construction Stenderds and Specifications 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. rU�3[: iG Gt10/._'.e=S �E/�:�iT �.JOT it'E'C�Ui,c�E� 2/ ��7 .� �� Approved for Consiruction Date FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everen, WA 98201 Phone.259-8815 ACKNOWLEDGEMENT OF CONDITIONS W H � The uiidersigned owner/applicant hereby a�rees to hoid and save harm- less the City ol Eaerett from 3ny and all claims for tlamages, costs, expenses, or �:auses of action that may ar�se because of installatlon and maintenance ol the improvement or otlier righFof-way use hereto applied lor and further agrees lo remove same upon notice Irom the City and to replace public proporty demaged thereby. Sic�nature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BV THE CITY UPON ANY STOPPAGE OF WOAFC ON THIS PROJECT OVER 90 DAYS DURATION.