1619 WALNUT ST 2016-01-01 MF Import

oate�y qpplicatic+n For PUBLIC WORKS PERMIT Print or Type Only 1�3L Address C �r�� fir City $4 88 p�plie Wa�b Peimit • a�ao oao� . �� Publ�w Woiks Fee s '7-17 ,� Toial Fee Less Appl Fao Peid s�0�� 6aiance Due s �� � S i-o l 'LS �9 Z�P Phone ZiP Phone Describe Proposed Work A�� ti�n G�A��f S iO rl.n�rr fNGE /a� r � ,a�N,vr ProJect Address pf known) Altach four (4) copies of plans for proposed work - Oraw to scale and note the following as applicable: • Property Lines • Outline end dimensions of all existing and proposed structures on lhe lot • Exlsting and proposed utililies • Centerline ol street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All cells for InsDeclio�i shall be made 24 hra in advance - Phone 259•8815. 2. All work shall be performed in accordance wiG: this permil end current Ciry of Everett Design end Consfruction Slandards and Sp^ciflcations 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•500-424-555 . Approved as everett e �.-� � = a-s � pUgLIC WORKS UEPARTMENT 3200 Cedar ":�eet Everett, WA 90201 Phone: 259-8815 W H � � � O � � O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/apPlicant hereby agrees to hold a�d save harm• less ihe City o� Gverelt irom any and all claims for damages, cos�s, expenses, or causes o� action Ihat may arise because ot installalion and maintenance ol the improvement or o�her right�ohway use herelo applied for and further agrees to rdamaged herebyn notice irom ihe Ciry and to replace Public property �Y-��iL�-. � , �.� �gy Dale Signature ol Applicant WORK AUTHORIZE� BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE PROJECT OVER 90 DAYS DUHATION. STOPPAGE OF'NORK ON THIS