430 WETMORE AVE 2016-01-01 MF Import

Date��Y ApDlication For PUBLIC WORKS PERMIT Print or Type Only PuoGc warkf Perm'n • eiao. oeo�. � `�ls `l /1-'3� Puellc works rea S Totei Fee Lesa RpD�� ree PeiE s Beiance Due � ��'�' Zip Phone Applicant Mailing Address City Deacribe Proposed Work Prolect Address (i� known) �-3 � � Attech four (4) co0ies of plena for proposed work • Draw to scale and note the following as applicable: • Property :ines • Centerline ot s�reet • Outline ond dimensions ol a�l existing and • Indicate Norih proposed slructurea on ihe lot • Show any proposed grading changes • Existinp and �'opoaed utilities � Show measurements PERMIT CONDITIONS 1. All cells for inspection shell be m�de 24 hrs. in sdvance - phone 259•8815. 2, All work shell be peAormed in accordance with this permit and current City of Everett Design and Construction Standerds and Specifications. 3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1�800•424•5555. P� ,,,,, ,� �ks �o ,� Q,�b� �P , �e��,�� 1`►0 �eSv � �� Approved lor Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPhRTMENT � 3200 Cedar Street Everelt, WA 98207 Phone:259�8815 �� rQ �" ° � �, I � ��-�l�y ACKNOWLEDGEMENT OF CONDITIONS W H � � � � �" � O a The undersiyned owner/applicant hereby agrees to hold and save harm- less Ihe City ol Everetl Irom any and all claims for damages, costs, expenses, or causes ot actior� that may arise because of installation and maintenance ol ihe improvement or other right-ol-way use hereto applied for and funher agrees to remove same upon notice irom the CitY and to replace public property damaged �hereby. Signature of Applicant Date WORK AI'THORIZEG BY THIS PERMIT MUST 13E STARTED WITFiIN 180 DAYS OF DATE PERMIT IS ISSU�:D AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCFLLED BY THE CITY UPON ANY ST,�PPAGE OF WORK ON THIS PROJECT OVER 90 DAYS �URATION.