2214 VIRGINIA AVE 2018-01-02 MF Import

,i--- --_-- --_ -- - – Date Application For �. PUBLIC WORKS RERMIT Print or Type Only � /,'� J N f�� 0 D=scribe Proposed Work .� L . PuOt¢ Worhs Peemn • eiea� oen�. r voeLcwcrksFae s Tolal Fee Less Aoo� Fee PaiC a Ba:anco Due S �� 0 / . �= �/r:,�7'T ;�. '�: �� --7 Not Zip Phone ' Ve�e?i�` N [/�� 7 ` ^': p� � Zip Phone � =�—�=�-�-�—� � J Cl:� �` Prolect Address (il known) / � 9 /'" �• � � I Attach four (4) copies of plans fo� proposed work • Draw to scale and note Ihe following as applicable: � • Properry Lines ,• Centedine of street ' • Outline and dimensions of all existing and • Indica�e North � proposed siructures on the lol • Show any proposed grading changes : • Existing and proposed utilities • Show me�surements PEFMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•861 5. 2, All worA shall be perlormed in accordance with ihis permit and current City ol Evnrett Design and Consiruction Standards and Specifications. 3. Cull �owtion Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1-$O�•424-5555. Approved lor Construction FINAL INSPFCTION Approved as Conslructed everelt PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett. WA 9ti201 Phone: 259�8815 W � � � � ACKNOWLEDGEIv1E1JT Of CONDITIONS The undersigned owner/applicant hereby agrees to holtl and save harm- — less the City ol EvereU Irom any and all claims tor damages, costs, � ezpenses, or causes ol action that may ari,e Uecause ol inslallation and maintenance ol the improvemenl or other rigM�obway use hereto applied for and turiher agrees to remove same upon notice from the Date Cily and to ieplacu public property damaged ihereby. Date — SignaWre ol Applicant Da1e WORK AUTHORIZED BV THIS PERMIT MUST BF STARTED WITY.IN 180 DAYS OF DATE PERMIT IS ISSUcD AND THEREAFTER,IS TO BE DILIGENTLY PURSUED TO COMPLETION. 1�HIS PERMIT IJ�AV BE CANC[LLED 9Y THE CITY UPON ANY STOPP�GE OF WGliK ON THIS PROJECT OVER 90 DAYS DURATION.