8214 XAVIER WAY 2016-01-01 MF Import

� -., �-- Oate� ' Application For PUBLIC WORKS PERMIT Print or Type Only Pu�hc Wo�hs Perm�t � .��p�p� Bieq. Deo�. • � � � �U U O� Public Wo�ks Fee s iolal Fee Leas POG�� Fee PaiE S Belance Due S Describe Proposed Work Prolect Address (il known) Attach four (4) coples o� Plans for proposed work - Draw to scale and note� Ceo11eWine of �Pee�cable: • Property Lines � • Indicate North • Outline and dimensions ot all existing and � Show any proposed grading changes proposed structures on the lot � Show measurements • Existing and oroposed utilities PERMIT CONDITIONS 1. All calls for inspection shell be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be peAormed in accordanre with this permit and current City of Everett Design and Conslruction Standards and Specificetlons. 3. Call Location Underground Service 48 hrs. before You dig. TOLL FREE NUMBER 1•800-424•555 . /�!/f3'6 /G Q'/O.C'•fS /`�E,[�/n�T �OT' �E�Qr/i.t�Fl� Approved for Consirudion Date FINAL INSPECTION Date qpproved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cr.dar Street Everett, WA 98201 PhOne: 259•8815 �/%�8 % c=,�� � O H N O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City oi Everett from any and all claims for damages, costs, expenses, or causes of action ihat may arise because of installation and main�enance of the improvement or olh2r right-ol�way use hereto applied for and further agrees to remove same upon notice irom Ihe City and to replace public properly damaged lhere6y. Deta Signature of APPlicant 80RD YSTOFRDATE PERMIT SEISSUED AND THEREAFTER ISHTO CANCELLEDTBY THE CI� Y UPONOANY STOPPAGEIOF WORK ON THIS PROJECT OVER 90 DAYS DURATION.