4028 SUMNER PL 2016-01-01 MF Import

, Date � /oZ Applicetion For PUBLIC WORKS PERMIT Print or Type Only �� Meiling Addr Deacrihe Proposed Prolect Address (if known) 2ip PUEI¢ Work� Peemit • eyr. oeo�- • — Leu v.�e f f Attach lour �4) copies of plana for proposed work • Draw to scale and note the follo as applicable: • Property Lines • Cen e of slreet � Outline end dimensions of all existing and • In e Norih p�oposed siructur¢s On �he lot • any proposed greding chanpes • Existinp end proposed utllities ow measurements PERMIT CONDITIOHS 1. All �:alle for Innpedion eheli be mede 24 hn. In � 2. All work ehall ba peAormed In eccardence with Sta�arda and Speclticatlona 3. Cell Locetion Underpround Servlce 4B hrs. bey � /n`��ie�J9� 3 �/ � Phone �phone 2b9-8810. rmit end curtent City ot Everett Design end Constructlon w dig. TOLL FNEE NUMBER 1•800'4i45555. �,,iT•s� c.ry v�-�� i �fri �J c�%�T� • ,� rs .�o I �� E�-, WQ �� %- Approved es Constructed �PUBLIC WORKS DEPARTMENT 3200 Ceder Streel EveretL WA 98201 P�one: 259-8810 �� �� � 9� ( ^ Q�7 ACKNOWLEDGEMENT OF CONDITIONS � The undersigned owner/applicant hereby agrees to hold end save harm• less the City of Everett Irom any and all claima for iamagas, costs, � expenses, or causes of action that may arise 6eceuse ol instelletion and maintenance of lhe improvement or other right�of•wey uae hereto appl�ad for and further agrees to remove same upon notice irom the � City and to replace public property dameged Ihereby. �'/vo/�iY Signature of Applicant a�e WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED � HIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTE BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT E CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK O THI PROJECT OVER 90 Dl�YS DURATION.