5404 S 2ND AVE 2016-01-01 MF Import

Date� � Application For PUBLIC WORKS PERMIT Print or Type Only Describe ProposeA Work n/P u� i�C_SICJ'2A/CE' Project Address (il known) _ � '�� PuOhc WorFs Pcrmil r '-� � '�� ema oeoi • � 1 �: 7� Vubi¢ Works fee To191 Fee $ - Less Apol Fee Pe�E $ exixoce ooe S ��— v��o��i5� %6z9� s68-i9a3 City Zip Phone 11 �l / I City Zip Phone Attach lour (4) copies of plans for proposed work - Draw to scale and note Ihe lollowing as applicable: • Property Lines • Centerline a� street • Oulline and dimen�:i�ns of all ezisting and • Indicale North proposed siructurr:s on the lot • Show any proposed qrading changes • Ezisting and pro; osed utilities • Show measure�nents PERMIT CONDITIONS 1. All calis lor inspec�ion shall be made 24 hrs. in advance - phone 259•881 5. 2. All work s�all be performed in accordance with Ihis permit and current City of Everett Design and Construction Standaril5 and Specilications. 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER �•800•424•5555. � �.6- �LL �!-. ^�- � T c��i Approved tor ConsiruG on // � Date � /v ��8� IN FECTION � pa� Approved as Canstructed evcrett PUBUC WORKS DEPARTMENT � 3200 Cedar Street Everett. lYA 9820t Phone:259�B815 ACKNO\NLEDGEMENT OF COND:TiONS W � N L� � N O a The undersignad owner/applicant hereby agrees to ho�d and save harm- less Ihe City ol Everett from any and all claims lor demages, r,osts, expenses, o� causes ol action that may arise because ol installation and mainlenance ol the improvement or other ri{thFof�way use hereto applied lor and further agrees to remove same upon notice trom the City and to replace public property damaged ihereby. —� � � �� Sign' lure ol Applicanl Datc WORK AUTHORIZED BY THIS PERMIT MUST BE STA�TED WITHIN 180 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCEILEC 6Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PNOJECT OVER 90 DAYS DURATION.