2218 STATE ST 2016-01-01 MF Import

Date_L�G-L�J �� � � Applicetion FOr PUBLIC WORKS PERIIAIT Print or Type Only �l-O � Owner Describe Froposed Work �i�� Address cny v�euc won�• v.,mn . BM7. UaM. � - Peoi¢wo.bFaa s TotN F�� Leu ADP� Fas P�iE _ e,i,��.o�. s A/[7 CNAeGFi � iE wouc.n l.��c.E Tv iuST/}c� P., 12' X l8� ��.tt '1'14RP _ ��.. ��. � Project Address (if known) Attach tour (4) copies ol plans for proposed work • Draw to scale and note the following as applicable: • property Lines • Outl�ne and dimensions of all exisling antl proposed structures on lhe lot • Ezisting and proposed utilities • Centerline of street • Indicate North • Show any proposed gradinq changes • Show measurements PERMIT CONDITIONS 1. All calls (or inspection shall be made 24 hrs. in advance - phone 259•8810. 2. All work shall be performed in accordence with thls permil and curre�t City of Everetl Design and Gonstruction Standards and Specificatlons. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. 4, 1�1a �.-.�Itiss �� a�tl�.l,od qs �,ch�b�f {� �-2 i � � ��-�� St 7 'z � � 5-f-<<-�� Date FINAL INSPECTION Date Approved as Constructed �A��PUBLIC WORKS DEPARTMENT 3200 Cedar Slreet Everelt. WA 98207 Phone: 259�8810 ACKNOWLEDGEMENT OF CONOITIONS W H � � � � � � � a The undersigned owner/applicant hereby agrees to hold and save harm• less the City ol Everetl Irom any and all claims lor damages, costs. ezpenses, or causes of action that may arise because ot instailation and maintenance of the improvement or other right•of-way use hereto applied lor and further agrees to remove same upon notice irom the �City and to fe lace public properiy d�ged� eb� y. � yd / 1�1 %��— i � /0-2.7-94 gnatur IApphcan. Dale O AUT ORIZED BY THIS PEFiMIT MUST BE S7ARTED WITHIN 180 D F DATc PERMIT IS ISSUED ANO THEREAFTER �S TO BE DILIGENTLY PURSUED TO C0�IPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON A�IY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.