10702 4TH AVE SE 2016-01-01 MF Import

Date�O� Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address � Describe Proposed Y/ork y�r,�l Lu �� L.q---�tL�-�1-L� Prolect Address (il known) PuLbc worFs Pe�mn s � Bitlg. DeO�� • Pu�lic Worb Fee $ To191 Fca Less Appl Fee Paitl � Balance Due $ :�/ � Zip Phone Zip Phone Attach low (41 copies of plans for proposed work - Draw to scale and note ihe tollowing as apPlicable: • Property Lines .• Cenlerline of street • Oulline and dimensions ol all existing and • indicate Norih proposed structures on ihe Iot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT C'�NDITIONS t. All calls for inspection shall he made 24 hrs. in advance - phone 2J9•881 5. 2. All work ehall be performed in accordance with ihis permil and current City of EvereU Design and Construction Standards and Specilications. 3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. %U7 ��%;�Vw' _ .�?l✓�' L'c?U./'C_� / ��i��i% �1,C'� �°=C��,cf_�_ � J?U/� � / Approved lor Consiruction FINAL INSPECTIOIJ Da�e Approved as Constructed ereretl PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259�8815 ACKNOWLEDGEMENT OF CONDITIONS The unders�gned owner/applicanl hereby agrees to hold and save harm- less the City of Everett Irem any and all claims lor damages, cos�s, expenses, or causes of action ihat may arise because of installalion and maintenance ol ihe improvement or other right-ol-way use he�eto applied for and further agrees to remove same upon notice hom ihe Ciry and to replace public property damaged iher=by. Signature ol Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS O� DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COIviPL[TION. THIS PERMIT �1AY BE CANCELLED BY THE CITY UPON ANY STOPPAGE V F WORK CN THIS PROJECT OVER 90 DAYS DURATION.