1010 NORTH PARK DR 2016-01-01 MF Import

� Date � Application For PUBLIC WORKS PERMIT Print or Type Only Appllcant Describe Proposed Work a Project Address (if known) / iJ � U /i � NC�.�_ �% Attech four (4) copies of plens for proposed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of ail existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS Pu0'it Works Permlt • v `� /��+ BI40.0¢GL+- �]r � 0 Pu011c Works Fee Tolel Fea S leaa Appt Fca Pald S B�Iance Oue S �� ,Gi7E ,�.d�U c�N �(Cm�T 8� - /yZ c�-ol -��/ • Centerline of street • Indicate North • Show any proposed grading changes • Show measuremenis - s6ao 1. AII calls tor inspection shall be made 24 hra in advance • phone 259-881 5. 2. All work shall be performed in accortlance with this permit and current City of Everett Design and Construclion Standerds and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. YJ-C2 � ,6�itrnf�- S�9/�S Approved for Co ruclion Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Streel Everett, WA 98201 , Phone:259�8815 ACKNOWLEDGEMENT OF COND�TIONS W � � � � O The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett irom any and all claims for damages, costs. expenses, or causes of action that may arise because of installation and mainlenance ol Ihe improvement or olher right•of-way use hereto applied for and Nrther agrees to remove eeme upon notice irom the City and to replace public property damaged thereby. Signature ol Applicanl Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.