4028 SUMNER PL 2016-01-01 MF Import

oateJ �' � Z' `� Z Appllcation For PUBLIC WORKS PERMIT Print or Type Only PuEi�e Wonu Parm�t � _ qz /�c/ BWp. Oepi. e PeElk WOA� Fe� Tot�l Fea � Lau �ppl F�a P�iC � B� ce Dus i .7'vAVT �'i7f� 7 � a� a�ez-ai.� Zip Phone Applicant Malling AAdresa City Zip Phone Describe Proposed Work �� Pro�ect Addrese (if known) Attach four (4) copies of plane for proposed work • Draw to scale anA note the followinp as applicable: • Property Lines • Centerline of street • Outline and dlmenniona o1 all existlnp end • Indicale North proposed structures on the lot • Show any proposed gradinp chanBes • Existinp and propoaed utililiea • Show measuremenls PERMIT CONDITIONS 1. All cells for Inspectlon eh�ll be mede 24 hre. In advance • phone 259$870. 2. All work M�II be peAortned in eaordence with thie permlt and current Clty ot Everett Desipn end Conatructlon 9t�ndards �nd SpecNlcations. 3. GII Location Undsryround Service 48 hro. before you dlp. TOLL FREE NUMSER 1-800�4246b55. `4, ds Pe,+" ,�1� a►-,d IeEE�er n��e�x,� frr� �enn� M, gn'�e, PE, datcd i•tv�er� be.r �o, �q9Z, C A ed for C truc De!e � /� � �. FINAL IN3PECTION Date Approved as Conetructed PUBLIC WORKS DEPARTMENT 3200 Cedar Straet Everott, WA 98201 Phone: 258-d810 ACKNOWLEDGEMENT OF CONDITIONS W H � I•1 u � � f' � The undersigned owner/applicant hereby agrees to hold and save harm- less the City o1 Everett from any and all claims for dameges, costs. expenses, or causes of action that may ariae beceuse ot instellation end melntenance ol the improvement or other righl•of-wey use hereto applied for and lurther agrees to remove same upon notice Irom the City and b replace public property� thereby. /, � Signature of Applicant Date WORK Al"'riORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1A0 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.