2509 W MUKILTEO BLVD 2016-01-01 MF Import

_ _ /� DatP�� / Application For P4JBLIC WORK� PERlIAIT PUEIic N�rka Peprmlt • �--- Bmv oeoi.. O �� .3�/ 6 `% PublicWorkaFea s Tol�l Fee Lea� �coL Fee PaiE S I6�lance Uue S Print or T�pe Only Mailing Address City Zip Phone Describe Froposed Work 1 '• �-� �^�� -�� `—�^�F`h� — Pro�ect Address (il known) Attach four (4) copies of plans lor proposed work • Draw to scale and note thu lollowing as applicable: • Proporty Lines • Centerline oi streel • Outline and dimensions ol all ezisting and • Indicate Norih proposed structures On�helot • Show �ny proposed grading changes • Existing and proposed u;ilities i� Show measuremenis PERMIT CONDITIONS t. All calls for inspection shell be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be periormed in accordance with this permit and current City of Everelt Desian and Construction Standards and Specilications. 3. Gall Localion UnJe:grccnd F^n�iac 48 h�s before you dig. TOLL FREE NUMBER 1•BOO•A24-5555. �J Approved tor Conslruction �� W '/ c/ n � nJ ��,� �ri/z � I' �� �" � y �'y FCKNOWLEDGEMENT OF GONDITIONS 3�F W H � � � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett Irom any and all clalms lor damages, costs. expenses, or causes ol action thal may arise because ol installation and maintenanr.e ot !he improvement or other rigM�ol�way use hereto applicd lor and lurther agrees to remove same upon nolice Irom the Dale City and lo replaco public property damaged thereby. FINAL INSPECTION Date Approved es Construcled everett PUBLIC WOFKS DEPARTMENT � 3200 Cedar Slreet Evere�t, WA 98201 Phonc: 259-8815 Signature ol Applicant Dat� WORK AUTHORIZED BY Tf115 PERMIT MUST BE STARTED WITHIN 1B0 DAYS Or DATE PEFMIT IS ISSU[D AND THEREAFTER IS TO BE DILIGEtJTLY I'URSUED TO COMPLETION. THIS PERMIT MAY aE CANCELL[D BY 1 HE CI fY UPON ANY STOPPAGE OF WORK ON TIIIS PROJECT OVER 50 DAYS DURATION.