20 SW EVERETT MALL WAY ARROW PEST CONTROL 2016-01-01 MF Import

Date��"O � �i Application For PUBLiC WORKS PERMIT Print or Type Only � IPuel¢1va�ksPe T=I 61�f9 O�pl. a ��` '�� Zx�— Pubhc Wmks Foo To�BI i'en $ LoysApPl.FrePai� S r„i,�« o�� S � Applicant MailingFddress Ciry Zip Phone Describe Proposed Work I �+-- • �� J'� h��C �� • Project Address (if known) Attach four (4) copies ol plans for propo�ed work - Draw to scale and note the lollowing • Pruperty Lines • Oueline and dimensions of all existing and proposetl structures on the l01 • Existing and proposed utilities i Centerline of street • Indicate Norih • Show any proposed grcding changes • Show measurements PERMITCONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All H�ork shall be pertormed in accordance with Ihis permit and current City of Everett Design and Construclion Standards and Speci�ications. 3. Call Location Underyround Service 43 hrs. before you dic�. TOLL FREE NUMBER 1•800-424-5555. Approved for Consiruction Da�e FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Lveretl, WA 98201 Phone: 259-B810 Date � �:�/� �<-r�-°- •f- i /-,y � ACKNOWLEDG[MENT OF CONDITIONS W H � � � The undersiqned owner/applicant heraby agrees �o hold and save harm� less the Cily ol Everell Irom any and all claims for damages, costs. expenses, or causes of action that may arise because of installation and mainlenance of the improvemenf or other righ�-ol-way use here�o applied for and Iwther a�rees to remove same upon notice trom the City and to replace public property damaged ihereby. Signature of : pplicant Date WOHK AUTHOFIZED A1' THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF GATE PEAMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLCTION. THIS PERh11T MAY BE CANCFLLED BY THE CITY UPON AhY STOPPAGE OF WOHK ON THIS PROJECT OVER 90 DAYS DURATION.