8214 XAVIER WAY 2016-01-01 MF Import

Date� 7 I • —�� Application For PUBLIC WORKS PERMIT Print or Type Only Mailing ! � x Describe Proposed Work� /U Project Address (il known) Address PubLc Works Permit r BIJB. Deol. r f�7�� PuEll� Works Fee Totel Fee S _ Leas AOP� Fec Fa�E S Balance Uue S Z�P Phone Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as applicable: • Property Lines • O�tline and tlimensions ol all existing and proposed structures on the lot • Existi�g end proposed utilities • Centerline of sireet • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calis for insp=ction shall be made 24 hra in advance • phone 259•8fi1 5. 2. All work shall be performed in accordance with ihis permit and current City ol Everett Design and Construction Standards and Soecifications. 3. Call Location Ur,derground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. �'!�6'� iC Cv��,rs �E��m�i ir�n,— ,c�E-q. Approved for Conslruclion Date FINAL INSPECTION Date Approved as Constructed everett PUBUC WORKS DEPARTMEMT � 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 io�i�a � `� ✓ ACKNOWLEDGEMENT OF CONDITIONS W � � � � 0 � � � a The undersigned owner/applicant hereby agrees to hold and Save harm• less ihe Citv of Everett from any and all claims br damages, costs, expenses, or causes of aclirn �hat may arise because of installatlon and maintenance of Ihe improvement or other right-of•way use hereto applied for and further agrees to remove same upon no�ice Irom the City and to replace public property damaged thereby. of Applicant Dete WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO 9E DI�IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 D4YS DURATION.