3617 W MUKILTEO BLVD 2016-01-01 MF Import

Date %/ 3 Application For PUBLIC WORKS r�ERMIT Print or Ty�e Only Address Address city Cily Z�P Public Works Pormil • a�da.o�o�.. �3//�/ 9 Publlc Works Fee s Ta101Fee Less AppL Fae Pnitl $ BelenceDue $ Phone Describe Proposed Work ' � '' ��• /c '� �T 4-7'1i .�/�n/- ��n�r/ ( /7� � ^[ c n T y ` . �� Pro�ect Address (if knowo) Attach four �4) copies of pians lor proposed work • Draw to scale and note the following as applicable: • Property Lines • Centerline ol street • Outline and dimensions ol all exisling and • Indicate North proposed struclures onthelot • Show any proposed grading changes • Existing and proposed utilit�es • Show measurements PERMIT CONDITIONS 1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shad be performed in accordance with this permit and wrrent Ciry of Everetl Design and Construction Standerds eoi Specificaticns. 3. Call Location �nderground Service 48 hrs. before You dig. TOLL FREE NUMBER 1•800•424-5555. Approved for Construction Date FINAL INSPECTIGN Approved as Constructed everett PUBLIC WORKS DEPAR1h�ENT � � 3200 Cedar Street Everelt, WA 98201 Phone: 259�8815 Gate ACKNOWLEDGEMENT OF CONDITION3 � O � � O a The undersigner; owner/appiicant herehy agrees to hold and save harm• less the City �f Everett irom any and all claims for damages, costs, expenses, or causes of action that may arise bec�use of installation and mainlen.�nce o( the impwvement or other righl•of-way use hereto applied for ar�d furiher agrees to remove same upon nolice from the City and to rep�ace public property damaged thereby. Signalure of Applican! �ate 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 1VORK ON THIS PROJECT OVER 90 DAYS DURATION.