1918 SUMMIT AVE 2016-01-01 MF Import

Date�� Application For PUBLIC WORKS PERMIT Print or Type Only owner / �/z�/ Pu�l¢ Wo�Fs Par BiJq OeO�� • PuDbc Worka fee s Total iee Lesa �ool Fee vaia s �J BalencaDue S/—� Applicant Mailing Address City 2ip Phone Describe Proposed Work ' ` �L� �� Proiect Address lif knownl 191F� SvMMIT Attach four (4) copias of Plans for proposed work - Draw to scale and note the tollowing as applicable: • Property Lines • Outline end dimensions of all existing and praposed structures on the lot • Existing and proposed ulilitles � Centedine of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDIT�ONS 1. All calls tor inspectlon ahell be made 24 hrs. In advance • phone 259•8810. 2. All work shall be pertormed in accordence with this permit and current City of Everelt Oesign and Construclion Stendards and Speclficeliona. 3. Cell Lxatio� Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800�4245555. �c�....9. V1/1 `��- Cp -G-� Approved tor Const ction �r- Date / �ll��-- io-//-t'e FINAL INSPECTION Da�e Approved as Construcled everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everel� WA 98201 Phone: 259•8810 ACKNOWLEDGEMENT OF CONDITIONS � O � � O a The undersigned owner/applicant herehy agrees to hold and save harm• less ihe City ot Everett irom any and all claims for dameges. cosis. expenses, or causes of action Ihat may arise because oi installation and maintenance ot ihe improvement or other right-oFway use hereto applied tor and further agrees to remove same upon nolice irom ihe Cily and to replace public property damaged thereby. / -�i/� � Q��i'��iY ir' -�� SI'gpJfure ol Applicant - """ �pRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1"80 DAYS OF OATE PERMIT IS ISSUED AND THEFEAFTER IS TO BE DIL�GENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON FNY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.