4020 SR 529 2016-01-01 MF Import

r. „ Date � �/C' . Application For PUBLIC WORKS PERMIT Print or Type Only s Ciry PuEi•c Works Permit e ___(�7��1h/ BiAp. DeD�- • a�en� won. r.a _ 5� �— Tolsl Fea S - Leas Appt Fae PeIE s� Oelenca Oue s s, rn � Z-ye Phone .. L�JiL�1��—�1� Z a a�- a�a�ia-��r.-��.��- L : .�- :' :� G ' ' , Project Address (if known) Attach four (4) copies of plans for proposed work • Draw to scele and note the following as applicable: • Property Lines .• Centerline of street • Outline and dimensio�s ot all existing and • Indfcate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS ' 1. All calls for inspection s�all be made 24 hra in advance - phone 258-881 5. 2. All work shall be performed in acwrdance with this permit and current Ciry of Everett Design and Construction Standards and Specificetions. 3. Call Location Underground Service 48 hra before you dig. TOLL FREE NUMBER 1-800•424-5555. � o�- SEP/,% �/O'`f -v 6 Date as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 9820t Phone: 259-8815 W H � � G� � � O � � L' 1 ACKNOWLEDGEMENT OF CONDITIONS _ The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Evarett from eny and all c�eims for damages, coste, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other righPof-wey use herelo applied for and furiher agrees to remove same upon notice irom the CNy and to replace public proFartY damaged thereby. . _ .. ,'WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1Q0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED�TO COMPLETION. THIS PERMIT MAY BE CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS OURATION.