3810 WETMORE AVE 2016-01-01 MF Import

,�at�Z ZB 6'> P pplication For PUBLIC VIIORKS PERMIT Print or Type Only Mai4ing Address Mailing Addres5 r. Describe Proposed Work I'��A« /�-C/%FL.c/%i� '� Projecl Address (il known) '�� —' Clty Puoec wo,�c Permil . V/ ; 7V � ema oeo�. • _ WL12 WarN ree Talal Fee f Le,s AnO� �ac FUE S Balancc O�e S �Q � D/ Attach four (4� copies ol plans lor proposed work - Draw lo scale and note the tollowing as applicable: • Property Lines • Outline antl dimensions of all ezisting antl proposed siructures on the lot • Existing and p.�posed utililies for FINAL iNSPI Approved as everett e • Cemerline of street • Indicale Norih • Show any proposed grading changes • Show measurements Phone PERMIT CONDITIONS 1. All call5 for inspection shall be made 24 hrs. in advance - phone 2$9•BBi �. 2. All work shall be pertormed in accordance with ihis permit and current City ol Everefl Design and Consiruction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 7•800-424•5555. r,�;.� v,��w,�y ,��-.� �, y �T,�ti��.�� .�,�,�,��,�� �—, PUBLIC WORKS DEPARTMENT 3200 Ceder Sireet Everett, WA 98201 Phone: 259-8810 �� _;:.�� ,:� ACKNOWLEDGEMENT OF CONDITIONS W H � � O H � O a The undersigned owner/applicant hereby agrees to holtl and save harm- --- less the City of Everett Irom any and all claims lor damages, costs, ezpenses. or causes of action thal may arise because ot installatlon �� fa _ and maintenance of the improvement or other righPof-way use hereto applied lor and furiher agrees to remove same upon notice from the ,!Date City and to replace pubBc property Oamagetl ihereby. I L �y � , � Date ,L�/ ' ,`'�% �Y ��0<su�0 Signatur ol Ap c nt � Date WORK AUTNORIZEU BY THIS PERMIT MUST BE STARTED \NITHIN 180 DAYS OF DATE PERMII IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANV STOPPA3E OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.