4220 S 3RD AVE 2016-01-01 MF Import

Date � �� qpplication For PUBLIC WORKS PERMIT Print or Type Only Address Describe Proposed Work � Proj�ct Address (if knownl Ciry � Zip rubl¢ worhs Per ut • - BIQB� Oepl. • Pu�IlcWoeMSFee S ioial Fea Less ApO�- Fea PeiO $ Balanca, Due $ .4tt�+ch lour (4) copies ol plans for proposed work - �rew �o scale and no�e the lollowing as applicable: • Property Lines .• CeNedine of sireet • Outline and di�nensions of all exisling and • Indicate Norih proposed s�rac�ures on ihe lot • Show any proposed grading changes • Ezisting and proposed utilities • Show measuremenis aSa- Ss9� �1��-'�" Phene Phone PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hra in advance - phone 259-887 $. 2. All work shall be pedormed in accordance with ihis permit and current City of Everett Design and Construction Standards and Specilications. 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•42$•55$$. __� /!' � ;" �> ; . �- / /f�;%�/��/ �if=/1%// ✓i ��t;// �— � /_S� /l�'�;I ,.' :" .' "/:% �i�%. - /1 �,,� f-/i � ��- T�r�� - -� %/._: 1 DC�T� '� � Approved for Construction Date FIIaAL INSPECTION Date Approved as Consiructed evemtt PUBL�C WORKS DEPARTMENT � 3200 Cedar Slreet Everett, WA 98201 Phone:259�8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � � a The undersigned owner/applicant hereby agrees to hold and save haim� less the City ol Everett from any and all claims lor damages, costs, ezpenses, or causes of action thal may arise because of installation and maintenance of Ihe improvement or other righl-of-way use herelo applied for and further agrees to remove same upon notice Irom the City and to replace public property damaged thereby. Signature ol Applicanl Date WORK AUTHORI2EU BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE CANCELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.