1916 SUMMIT AVE 2016-01-01 MF Import

� •Date / S • Pu01¢ Worhs Peimlt d•� APPlica�ion For Bmg. oco�.. p_� �S�" 9C� PdJBLIC WORKS PERMIT Print or "fype Only Owner Applicant Describe Proposed Work Mailin9 Prolecl Address (if known) � �' ess City Zip Publ¢WoihSFeB a iotal iea Lass ApO�� Fea Paitl $ BalancaDuc $ Attach four (4) copies of plans for proposed work - Draw to scale and note Ihe following as applicable: • Property Lines • Centerline ol street • OuUine and dimensions ot all existing and • Indicate North proposed structures on the lot • Show any proposed c�rading changes • Existing and proposed utililies • Show measurements PERMIT CONDITIONS +. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be perinrmed in accordance wi�h this permit and current Ciry ol EvereU Design and Consiruc�ion Standards and Speciricatio,is. 3. Call Location Underyround Service 48 hrs. before you diy. TOLL FREE NUMBER �•800•424-5555. %�c'� �l�Biil ./�Jf�.��s �'F,��i7" ,E'Fc�ui,�F.v �� /� �� -�S Approved for Canstruction Date FINAL INSPECTION Approved as Conslructed evcrelt PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everelt, WA 98207 Phone: 259-8815 ACKNOWLEDGEMENT UF CONDITIONS W H � � � O H � 0 a The undersi�ned owner/applicant hereby agrees to hold and save harm- less the City of Everett Irom any ard all claims lor damages, costs, expenses, or causes ol action ihat may arise because ol installation and maintenance of the improvement or other righhol-way use hereto applied lor and lurther agrees to remove same upon notice irom ihe City and to replace public property damaged ihereby. Signature ol Applicant Date WORK AUTHORI2ED BY TfilS PERMIT MUST BE STARTED WITHIN 180 DAVS OF npTE PERMIT IS ISSUED AND TH�REAFTER IS TO BE DILIGENT�'�� I'URSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.