2515 W MUKILTEO BLVD 2016-01-01 MF Import

Date�L4u(/ Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Describe Proposed Work Project Address lil known) ess Zip Zip Attach lour (4) copies of plans for propoaed work - Oraw lo scale and note the following as applicable: • PrOperty Lines • Outline a�d dimensions of al� existing and proposed struclures on the lot • Existing and proposed utilities PUEI¢ Works Permll • Blep. Dapt � ��- PUEIicWorkSFea s Total Fee Less Fuo� Fee Ve�C S Ba�ence Oue • Centerline of streel • Indicate North • Show any proposed grading changes • Show measuremenis Phone � PERMIT CONDITIUNS 7. All calls tor inspection shall be made 24 hrs. in advance - phone 259-887 5. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications 3. Call Location Underground Service 48 hrs. br.fore you dig. TOLL FREE NUMBER 1•800-424•5555. /�/Gc� �F,�ir�iT /�or' ��C,��ii.c�C'U� � �� B6 � � Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259•8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett irom any and all claims for tlamages, costs, ezpenses, or causes of action that may arise because ot installation and maintenance ot the improvement or olher right•ohway use hereto applied for and further agrees to remove same upon notice trom the City and to replace public p�operty damaged thereby. Signature of Applicant Dale WORK AUTHOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT i5 ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 OAYS DURATION.