3606 W MUKILTEO BLVD 2016-01-01 MF Import

Date 2 22 91 Application For PUBLIC WORKS PERMIT Print or Type Only PUEIic Wo�ke Permll � _ BIaq.Oept. e 91/26531 PuDI¢ Works Fee s Tota� Fee Less AGC� Fee Putl S . Balence Due T� Nielsen 5718 — 96th SW Mukilteo, WA 98275 355-0620 Owner MaiHng Address City Zip Phone owner Applicant Mailing Address City Zip Phone Describe Propos�C Work ��'�m addition t: Prolect Address (if known) Attac� four (4) copies of plens for proposed work • DraN to scale and note the following as applicable: • Property Lines • Outline and dimensions ol all existing and proposed siructures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measuremenis PERMIT CONDITIONS 1. All cells for Inspection shall be mede 24 hrs. in advance • phone 259-8810. 2. All work ahell be peAormed in eccordance with this permit and curtent City of Everett Design and Constructicn Standards and Speclfications. 3. Call Lxation Underground Service 48 hrs. befora You dig. TOLL FREE NUMBER 1-800-4245$55. u/o� �..e�-f �� 'Pe�`v.t..- Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Ceder Slreet Everel�, WA 98201 Phone:259•B810 c��s-�� ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigned owner/applicent hereby agrees to hold and save harm- less the City of Everett Irom a�y and all claims for daniages, cosis, expenses, or causes of nction that may arise because ot installation and maintenance ot the improvement or other right-of•way use hereto applied tor and further agrees lo remove same upon notice irom the Cily and to replace public property damaged thereby. Signature of Applicant Deta 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 BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURAT�ON.