5115 S 4TH AVE 2016-01-01 MF Import

Date �'%� - �' 3 Application For PUBLIC WORKS PERBVI�T Print or',Ype Only nt Describe Proposed Work P�alect Address (i� known) Attar,h four (4) copies of plans (or pioposed work - Draw fo • �roperry Lines � Oulline and dimensions o� all existing and proposed strur.tures on the lot � Existing and proposed utilitins lor PERMIT CONDITIONS Pupl¢ Works Permit s —� �,3 �— B�4B- Oepl. � _ rwn� yyorks Fee —��— Toial Fee $ ��1. C1 G —_ Less Aool Fe,e Paitl $_�_ U '- Belence Due ily City • Centerline o� street • Indicate North � Show any proposed gradinc7 changes • Show measurements 1. All calls for inspection shall be made 24 hrs. in ativance - phone 259•88j 5. 2. Ail work shall be performed in accordance wilh this permit and current City ol Everett Design and Construction Stantlards and Speci'ications. 3. Call �ocation Underground Service 4g hrs. belore you dig. TOLL FREE NUMBER 1•$00•124-5555. `� � — _!•' _i� J ` J � � Approved as Cons�ructed evcrett PUBLIC WORKS DEPAR7MENT � 3200 Cedar Sireet Everett, Wq gg2p� Phone:259�8815 -�P3 Dale M � �w _/ O a ACKNOWLEDGEMENT OF CONDITIONS ihe cndersigned owner/applicant hereby agrees to hold and save harm- less the City ol Everett from any and all claims for damages, costs, expenses, or cauc_s of action ihat may arise because ol installation and mainlenance of Ihe improvemen� or olher right-of�way use hereto applied for and further agrees to remove same upon nolice Irom ihe City and to replace public Property damaged ihereby. Sign3ture of Applicant � WORIC AUTHORIZED BY THIS PERMI7 MUST BE S7AR7ED WITHIN 1B0 DAYS OF DqTE PERMII IS ISSIiED AND THEREAFTER IS TO BE DILIGENTLY PURS�ED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGC OF WORK ON THIS PRO.IECT OVEq g0 DAYS DURATION.