5107 WOODLAWN AVE 2016-01-01 MF Import

Date�=p� � Application For PUBL.�C WORKS PERMIT Print or Type Only Mailing Address City 2ip Pu04c Works Pnrmlt � aiae o�ai.. G �� Public Works Fee s Tota1 Fee Lens A00� Fee PaiO S Balance Due s � �{�.C� Applicant Mailing Address City Zip phone Describe Proposed Work Project Address (if known) Attach lour (4) copies ot plans for proposed work • Draw to scale and note the fotlowing as applicable: • Property Lines • Outline and dimensions ot all exisling and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS • Ce�terline of street • Indicate North • Show any proposed grading chenges • Show meesurements 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be peAormed in accordance with �his permit and airrent City of Everett Design and Construction Standards and Specilications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. /G�l/BL. if. C�Jo/�,�f �E_.�iniT .fJOT . � � G'Uii'E:O Approved tor Consirucbon Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everetl, WA 98201 Phone:f59-B815 S cQ-8% - � �� ACKNOWLEDGEMENT OF CONDITICNS W H � � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses, of CauSes Of aClion that may erise betause of in5lallation and mainlenance of the imUrovement or other righhobway use hereto applied for and further agrees to remove same upon notice irom the City and to replace public property damaged thereby. Signalure of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAl' AE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIiIS PROJECT OVEF 90 DAYS DURATION.