7121 YEW ST 2016-01-01 MF Import

�. - ��li'�1� Application For PUBLIC WORKS PERIIAIT Print or Type Only �--- PubL[WorwyPer �� e�e9 Deo1 • . � NOLircWorksiee -- iOtnllpe f LessAnni FerPqi� s q��Oc� BalanceDue f i.i�-" � k Applicant Describe Proposed Work Projecl Address (if known) � � Z Address Attach four �4) copies of plans for proposed work • Draw to scale and note Ihe following as applicable; • Prope�ty Lines • Outline and dimansions of all existing antl proposetl StruCtureS On ihe lOt • Existing and proposed utilities • Centerline of street • Indicate North � Show any proposed grading changes � Show measurements Phone PERMIT CONDITIONS t. All cells (or inspection ahell be made 24 hrs. in advance • phone 259-8810. 2. All work ahall be pertormetl in accoidance with this permit and cunent City nf Everett Design and Const�uction Standerds and Specificetlons. 3. Call Locntion Untlerground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800-QQ4•5555. A � /�A I CtZL�'Il�� '� �c�� Approved lorf� slruction Date i// ��' A ', /.r S � / f FINAL I SPECTION ! Dale Approved as Consiructed everett PUBLIC WORKS DEPAR7MENT � 3200CederSireet Everetl, WA 98201 Phone:259•8810 ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � � a The untlersiyned owner/applicant hereby agrees to hold and save harm� less the City ol Everett irom any and all claims lor tlamages, cosls. expenses, or causes of action that may arise because of installation and maintenance ol the improvement or other righf-obway use hereto applied lor and lunher agrees to remove same upon notice irom the Ciry anA to replace public property damaged ihereby. !.�—'�'- X/ Signatur� ol Appl¢ant D2IP WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PER\11T IS ISSUED ANO THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.