8130 XAVIER WAY 2016-01-01 MF Import

Dete �1��P Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Describe Proposed Work c�iy Ciiy Project Address lif known) — Attach lour (4) copies ol plans for proposed work • Draw to scale and note the Ioliowing as applicable: • PropertY Lines • Outlina and dimensions of all ezisting antl proposed structures on the lol • Existing and proposed utilities Pu�nc Worxe Pe� It�--- i�� —'—P BIDB DaO�� • PuEIm Worhs Fee s Totel Fee L¢69 Rppl F!B PBiJ S` BSIBnCB�UR + • Centedine of street • Indicate North • Show any proposed grading changes • Show measuremenls rnone rnone PERMIT CONDITIONS 1. All calls tor inspection shall be made 24 hrs. in advance - phone 2b9•88� b. 2. All work shall be performed in accordance with this permit and current Ci1y oi Everelt Design and Construction Standards and Specificaliona 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. /DC/6'G/� GU�J.�'.�s �E.C'isiiT ifi�'jT �F r C�Ui�F� /O/�B6 �� for Consiruction FINAI. INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street EveretL WA 98201 Phone:259�8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � � The undersignetl ownedapplicaM hereby agrees to hold and save ha�m- less the City ol Everetl irom any and all cleims for damagas, costS expenses, or causes of action ,.•" may arise because of instellation and maintenance of ihe improveme.' ^r other right•ohway use hereto applied for and furiher agrees to remo:�+ same upon notice from the Date City anc to replace public property damaged thereby. Signature ol App''.c[nt Da�e WORK AUTHOf�12E0 �Y THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.