938 W MUKILTEO BLVD 2016-01-01 MF Import

Date_�� 7 � —/ Application For PUBLIC WORKS PERMIT Print or Type Only �U,� �-.f.�� a,�� a 3ia -�� O� ner Mailing Address PP�� A ��a�� Mailing Address Describe Proposed Work Project Address (if known) %'{ � '� City Public Woiks Permlt s �'� � �L 'L �D�% 9lep. Dept. r � IX�7`Yi• Pu01ic Works Fe^ Tatel Feu § Less AOP�. Fee PeiE � Balance Duo S /— � �� Attach four (4) copies of plans for proposed work - Draw to scale and note ihe following as applicabie: • Property Lines .• Centerline of street • Outline and dimensions oi all existing and • Indicate North proposed structures an the lot • Sho�•i any proposed grading changes • Existing and proposed uti�ities � Show meaeurements PERMIT CONDITIONS Phone Phone 1. All calls for Inspection shal� be made 24 hra in advance • phone 259-8815. 2. All work shell be performed in accordance with this permit and current City ol Everett Design and Construction Stendards and Specifications. 3. Cali Location Undeiground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. __ � �, G� ✓w �'[� y�'.7— 7 � O�7 Approved for Con� n Date � //- � -�� FINAL INSPECTION Date Approved as Consiructed evere[t PUBLIG WORKS DEPARTMENT � 3200 Cedar Slreet Everett, WA 98207 Fhone: 259•8815 ACKNOWLE�GEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City ol Everett from any and all claims tor damages, costs, expenses, or causes of action lhat may arise because of installation and maintenance of the improvement or other right•of•w•ay use hereto applied lor and further agrees to remove same upon notice from the City anA to replace public property damaged thereby. .,��)�ii�n f•o i ,j,–1 L�— ,�C�s;� �s•- _�%L : �.��- =_�. ��d'% Signature df Applicant �� '�— WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITNIN 180 DAYS OF DATE PERMITIS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERNIIT MAY BE CANCELLED 6Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURAT�ON.