2420 VIRGINIA AVE 2018-01-02 MF Import

Date��`f qpplicalion For PUBLIC WORKS PERMIT Print or Type Only Owner �-�� Applicant Mailing 0 Descritre Proposed Work / �J �C /.� ��-1� vr tie.��P �..,3' � Pu�im Works Ve�m�t p 9iCp. Decl. s �� / V /� Vub6c worke Fee s —� Total Fea Lase AV�< <en Paid s —�� Balance Due Project Address (if kncwn) " � -" - Attach lour (4) copies ol pians lor proposed work - Draw to scale and nole � Cen�1ewine ol sUeeii able: • Property Lines • Indicate North • Outline and dimensions of all existing and � ghow any proposed gradiny changes proposed struclures on the lot � Show measurements • Existing and proposed u�ilities Phone PERMIT CONDITIONS 1, All calls tor inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All �vork sh2il be performed in accordance with this permit and current Ciry of Everelt Design and Construction Standards and Specifications. 3. Call Location Underqround Service 48 h�s. belore you dig. TOLL FREE NUMBER 1-500•424-555 . ��1�s ly° �w�'I � �%�' ''� � ` � � ,o C�,�u� .�,�L3-YY � ��,�� ACKN W EDGFMENT OF CONDITIONS Approved tor Construction Datc FINAL INSPECTION Date Approved as Conslrucled everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Streel Everett. WA 98201 Phonc: 259-8815 W H � � � 0 � � � a The undersipned owner/applicant hereby agrees to hold and save harm- less the City ol Eve�ett from any and all claims lor damages, cosls, expenses, or causes ot action ihat may arise because cf installation and maintenance ol the improvemenl or other right•ot�way use hereto applied !or and lorther agrees b remove same upon notice trom the City and to replace public property damaged �hereby. Signature of Applicant 80RDAYSTOFRDATE� PERMIT ISEISSUFD AND THFI7EAFTER ISHTO BE DILIGENTLY PURSUED TO COb1PLETION. THIS PERMIT MAY BE CANCELLED BY THE GTY UPON ANY STOPPAGE OP WORK ON THIS 1'ROJECT OVER 50 f.1AVS DURATION.