1004 W MUKILTEO BLVD 2016-01-01 MF Import

Date.�� 7 Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Describe Proposed Work Project Address (if known) HdOfBSS � Atta�h faur (4) copies of plans Mr proposed work - Draw to scale and note the following as applicahle: • Property Lines • Outline and dimensions of sll existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS Pu01ic Works Permii • �� / Bltlg. DoO�� /' � ' '/ � % / {�{�_ � i � - — PUEIIc Wa�ks Fei� Totel Fea S LesaAppLFeePa�E S }' BBIBnCB DUB S '^ v� � Centerline of street • Indicate North • Show any proposed grading changes • Show measur=ments 7ys-9�Dy Pho�e 1. All calls tor inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. A�I work shell be performed in accordance with this pe�mit and current City of Everett Design and Construction Stantlards and Specifications 3. Ca�l Locetion Urderground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•$00-424•5555. � � n � / %-� / i , �� " �'.,� � r_ l_o Approved for Consf Date i --�lJ— FINAL tNSPE ION � Date Approved ns Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett WA 98201 Phone: 259•8815 ACnNOWLEDGEMENT OF CONDITIONS The undersigned uwner/applicant hereby agrees to hold and save harm• less the City of Evnrett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installatlon and mainlenance of the improvement or other righPof•way use hereto applied for and further agrees to remove sane upon notice from the City and to replace public property damaged thereby. �a�� .5.�� !ya-.s t�� .. r> . • �_.Sl�� _�/.s/J'�7 Signatur 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 BF. CANCELLED RY THE CITY UPON :.NY STOFPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.