1906 W MUKILTEO BLVD 2016-01-01 MF Import

DateyZ��> Applicotion For PUBLIC WORKS PERMIT Print or Type Only � � ,� / 9 OG �t�l��,/frd I�UYIC.IJ Describe Praposed Work Project Address (If known) ✓'^�4- Pupll^. Worke Parmil � _Ci%� eiaa oao� • Pupii�Work�Fee �'/� Total Fae S _� LeasRppLFeePaIE �i.� Belanca �ue .S Z Q - a-a3 3s"� � ��y Attach four (4) copies ol plans lor proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • �ndicate North proposed structure� un ihe fot • Show any proposed grading changes • Existing and propoaed utilities • Show measurements PERMITCONDITIONS 1. All calls �or inspection shall be made 24 hrs. in advance - phone 259•8815. 2. All wprk shall be performed in accordance with this permit and current City of Everett Design and Consiruction Standards and Specilicationa 3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800•42�{•5555. ¢ �.�r s.��' ��f y„��o s: p /� Qi�v�c�� vsf �e pproved as Constructed evere[t PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259-8815 �-eMov�� ACI�NOWLEDGEMENT OF CONDITIONS W � � � � � � � O a The undersignr.d owner/applicant hereby agrees to hold antl save harm- less the City ol Everefl from any and all c�aims for damageS costs. expense=, or causes of action ihat may arise because of installatian and meinlenance ol the improvement or other righFof•way use hereto apnlied lor and luriher agrees to remo��e same upon notice from ihe City an� replace public property demeged thereby. ' f%7�f%/ ignature ot Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DA1'S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 8E DILIGENTLY PURSUED TO COMPLETION. THIS PERM�T MAY 6E CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS �URATION. �, 1 � � �