6012 ROCKEFELLER AVE 2016-01-01 MF Import

i Date� �/�/ Application For PUBLIC WURKS PERMIT Print or Type Only �5`�I �'�r �� Owner 11 Applicant Describe Proposed Work Mailing Address Mailing Address FJ City Pubhc Wmks Permil a BIEg. Oept � __ Pu�lic Worhs Fee $ TolelFee less ApP� Fea Paitl 5 Balancn Due y _ � pI �ue,c�/g�zo_� Zip Ph� Zip Project Address (it known) Attach four (4) copies oi plans for proposed work - Draw to scale and note lhe following as applicable: • Property Lines • Outline and dimensions of all existing anu proposed structures on lhe lot • Exi:ting and proposed utilities • Centerlinc o! street • Indicate North • Show any proposed grading r.hanges • Show measurements PERMIT CONDITIONS t. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction Standards and Specilica;ions. 3. Call Location Underyround Service 48 tirs. before you dig. TOLL FREE NUMBER 1•800-424-5555. y_ �� = ��. �� < <��= � � ,�'�� � ii.� f�`%-- �/�11i .C'cc^G*"/- `�;'- -`��"� ' FINAL INSPECTION qpproved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Sireet Everet6 WA 98201 Phone: 259�8875 Date ACIMOWLEDGEMENT OF COIJDITIONS � _. W H � � � � The undersigned owneUapplicant hereby agrees to hold and save harm- less the City ol Everett from any and all claims for damages, cosis, r.xpenses, or causes of action lhat may arise because ol installation and maintenance of lhe improvement or other righbohway use hereto applied for and lurther agrees to remove same upon notice rom ihe i q1nd to replace public ro erly damaged thereby. � � ,�� / Signature ol Appli nt Date WORK AUTHORI ED 8Y T�iIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF W6RK ON THIS PROJECT OVER 90 DAYS DURATION.