2212 W MUKILTEO BLVD 2016-01-01 MF Import

Date��- 1 r, - ;, . Application For PUBLIC WORKS PERMIT Print or Type Only ng Address Describe Proposed Work Project Address 1if known� �'uplm Wo�ks Parmit�___I�1L�[�_ ' BIaB De�l. • � Publ¢WorFgFee s To�e� Fee less Ap01. Fee PniJ S n pelanceDue s x0� Y 4 d! `f 7� 7JU Zip Phone Zip Phone e�enrh Inur �a1 cooies of plens lor proposed work - Draw to scale and note the tollowing as applicable: • P�operty Lines � Outline and dimensions of all existing and propos d structures on the lot • Existing and proposed utilities • Centerline of steet • Indiwte North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspecllon shall be mede 24 hrs. in advance • phone 258•8810. 2. All work shall be performed in eccordenc^ with lhis permit and current City of Everett Design end Construction � Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424'S555. //989 .i c- Approved lo� Co structlo6 Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 CedarStreet � Everetl, WA 98201 Phone: 259-8010 ACKNOW!-EDGEMENT OF CONDITIONS Th� undersigned owner/applicant hereby agrees to hold and save harm- less the City ol Everett Irom any ar.d all claims for damages, costs, expenses, or causes of action that may arise because of installatinn and maintenance ol the improvement or other right�ol-waY use hereto applied tor and lurther agrees to remove same upon notice irom the Ciry and to replace_ ublic roperry damaged thereby. .. — goa re of Applicant Dal WORK AUTHORI2ED BY THIS PERMIT MUST BE STAFTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.