2311 TAYLOR DR 2016-01-01 MF Import

Date�� 1 Application For PUBLIC WORKS PERMIT Print or Type Only H�OfQ55 Describe Pruposed Work �L�,( // \,J Project Address (il known� L1�Y Puel¢ Waks Permn s -�� BIQB. Oepl. + Puelic works Fee s Totel Fee Lest Appl Fee Pa1C $ BelanceUue S Attach four (4) copies of plans lor proposed work - Draw lo scale and note ihe Icllowing as applicable� • Property Lines • Centerlinr of streel • Outline and dimensions of all ezistiog and • Indicate North p�oposed slructures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS Phone 1. Ail calls f�r inspecfion shall be made 24 hrs. in advance • phone 259•8815. 2. All work shall be performed in accordance with ihis permit and current Ciry of Everefl Design and Construction Standards and Specilications. 3. Call Localion Undergrountl Service 48 hra before you dig. TOLL FREE NUMBER 1-800•424•5555. f v�3� / C GcJo2/Gs' ��-'��n�r n/o� �E'�y v�,e�'v `�l� G B7 Approved for Consiruction Date FINAL INSPECTION Date Approved as Consiructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett. WA 98201 Phone: 259•8815 ACKNOWIEDGEMENT OF CONDITIONS � � � The undersigned owner/applicant hereby agrees to hold and save herm- less the City ot Everett irom any and a!I claims for damages, costs, expenses, or causes o� action that may arise because of instettetion and maintenance of lhe improvemenl or other rightrof-way use hereto applied tor and further a5rees to remove same upon notice from the City and to replace public property damaged thereby. Signature ot Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THiS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS JURATION.