500 WOOD PL 2016-01-01 MF Import

D ate�-lx-� � Application For �UBLIC WORKS PERMIT Print or Type Only Address � Pu�bc Woeks Pc�rmi� s^7 �/ Bldg �epi. + _[]_I r� fLL— a�er� wo�ks v�� g Totel Fce Less ADO� Fce Pni� S Balxnco Ouo S City - — ZiP Phone App�icant Mailing Address City Zip Phone Describe Proposed Work �11-�L1L—i Project Address (il known) Attar,h tour (4) cOpies of plans for proposed work - Draw to scale and nole ihe lollowing as applicable: � Property Lines .• CeNerline ot street • Outline and dimensions of all existing and • Indicate North proposed structures on the IM • Show any proposed grading changes • Existing and proposed utililies • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advanca - phone 259•881 5. 2. All work shall be pertormed in accordance wilh ihis permit and currenl Gily of Everetl Design and Construction Slandards and Specifications. 3. Cali Location Underground Servica 48 hrs. before You dig. TOLL FflEE NUMBER 1•800-424•5555. /��j-iL�� Ltl��i'�S for Conslruction f�E'._��.,-�i T/VOT .t c GY�i,c��.J J Z-z'�7 ,(,?i, Date FINAL INSPECTION Date Approved as Construcled everett PUB�IC WORKS DEPARiMENT � 3200 Cedar Streel Everett, WA 98201 Phone: 259•8815 ACKNOWLEDGEMENT OF CONDITIONS 7 W H � � � O H N O � The undersigned owner/applicant hereby agrees to hold and save harm- less lhe City of EvereU irom any and all claims lor damages, costs, expenses, or causes of aclion ihat may arise because of installation and main�enance of ihe improvement or other right-oFway use herelo applied for and lurther agrees to remove same upon notice trom the City and to replace public property damaged thereby. Signature of Applicant Date WORK AUTHORIZ�D BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PE(iM1T IS ISSUED AND THEREAFTEf? IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.