5116 WOODLAWN AVE 2016-01-01 MF Import

i Date Applicalion For PUBLiC WORK� PERMIT Print or Type Onl� Address Mailing AdAress Publ�c AYmhs Fcrmit y ^�{ BIOg. Depl + ' ` '' �� Puefc works Fce S Totni Fca Less ApO�� Fex PaiO S Balancc Oue � Zip Nnone Phone � — 7�Ic� Describe Proposed Work � n�l �n� - Proiect Address lil known) Attach four (4) copies oi plans lor proposed work • Draw to scale and note the lollowing as applicable: • Property Lines • Outline antl dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Cenlerline ol sireet • Indicate North • Show any proposed gradin� changes • Show measurements PERMIT CONDITIONS 1. All calls tor inspection shall be made 24 hrs. in advance • phone 259•8815. 2. All work shall be perlormed in accordance with this permit and current City ol Everetl Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. /'G�/'L /C Cc �h.c',C.S� j�F�i��i% /Z�'i i(�F�2'�i,C'E/� Approved lor Consirudion Date FIN�L INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, VJA 98201 Plione: 259-8815 .S/;s�i �—�j� ^� / ACKNOWLEDGEM[NT OF CONDITIUMS W H � � � O The undersigned owner/applicant hereby agrees �o hold and save harm- less Ihe Ci�y ol Evere�� Irom any and all claims for damages, costs, expenses, or causes of action lhat may arise because of installation and maintenance ot the improvement or olher right�ol-way use hereto applied for and further agrees to remove same upon notice Irom ihe City and lo replace public property damaged thereby. Signal�:^ of Applicant Date WORK AUTHORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLEO BY THE CITY UPON ANY STOPP�GE OF WORK ON TIiIS PROJECT OVER 90 DAYS DURATION.