6720 WILLOW RD 2016-01-01 MF Import

Date�� e� Application Fur PUBLIC WORKS PERMIT Pn,it or Type Only 7, c��v i•� _� P�oe� wo�ks a�rm�i_� C/SL �-' BIeB Deo�� PWI¢WodsFee S TOtal Foa less P00� Fee Paia S Balanco Due S q"" PP�icyn' Mailing Address City Zip Phone Describe Proposed Work �'""[. �n � V�� Project Adtlress (il known) Attach fou• (4) copies of plans for proposed work • Draw to scale and note the lollowing as aUPlicable: • Property Linas • Centedine cl sireet • Outline and dimensions of all existing and • Indicate Norih proposed structures on the lot • Show any propnsed grading changes • Exisling and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. 2. All work shal� he performed in accordance with ihis permit and current Cit�• of Everett Design and Construction Standards and Specifications. 3. Call location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•B00•424-5555. %'</i�G/c Gvo�.�'s fi3-2��7�T .+/�T ,�',�= l' Ui� _Fv � �/er� �� Approved for Conslruction Date FINAL INSPECTION Date Approved as Conslructed evemt[ PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everet6 WA 98201 Phona 259�8810 ACKNOWLEDIiEMENT OF CONDITIONS W H � � � O � � 0 a The uc )ersigned owner/applicant hereby agrees to hold and save harm- less ihe City of Everett trom any and all claims for damages, costs. expenses. or causes ot action that may arise because ol installation and maintenance ol ihe improvement or other righFof-way use hereto applied lor and lurther agrees to remove same upon notice Iro�n the City and to replace public property tlamaged thereby. Signature of Applicant Date Wr 1UTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN 180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAV 8[ CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVEF 90 DAYS DURATION.