1002 W MUKILTEO BLVD 2016-01-01 MF Import

Date�=`� � Application For PUBLIC WORKS PERMIT Print or Type Only Address Pepllc Y/orks PermH • �" / � eiaa. odPi.. PuEllc Worke Fea Tolal Fee s Lasa ApPL Fee PSIE S Balenca Due S �Q OO ��.�?'sC Applicant Mailing Addrass � City Zip Phone Describe Proposed Work ��1 L�,��cC Pro)ect Address (if known) Attach four (4) copies of pians for proposed work • Oraw to scale and noto the followin�, as applicable: • Property Lines � Centerline of street • Outline and dimensions of t" existing and � Indicate North proposed siructuras on the lot • Show any proposed grading chenges • Eziatfng and proposed utllities • Show measurements INAL INSP pproved as werett � � PERMIT CONDITIUNS 1. AII calls for inspection shall be made 24 hrs in advance • phone 259•8815. 2. All work shall be performed in accordance with this permtt and current City of Everett Design and Construction Standards and Specilicetions 3. Cell Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800-424-5555. i iy� � �_�� G�T s�oE sc-�✓F� �o� �T.� ,-�o�-T RoN m�� ;e PUDLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259•8815 �-� ACKNOWLEDGEMENT OF CONDITIONS W H � The understgned owner/applicant hereby agrees to hold and seve harm- less the City of Everett from any and all claims tor damages, costs, expenses, or causes of action that may arise because of Installetion and maintenance of the improvement or other righhof-way use hereto applied for end further agrees to remove same upon notice irom the City and to replace public property dameged thereby. �',�� .��9�'? Signature of Applican '� Dete WORK AUTHORIZED BY TF'IS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMFLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON �VY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIpN.