433 50TH ST SW 2016-01-01 MF Import

�8t@_��! Application For PUBLIC WORKS PERMIT Print or Type Only ... - .s6 Public Works Cermil M '�'T�' � eia9. ooa�. • Public Worka Fxa s Tolal Fee LaelApPl. Fae Pald S _�—� ' Belence Due s — �=�� - ^ Describe Proposed Work �rt �1� � — Prolect Address (if known) `'T>�,� "`" Attach foi�l (4) copies uf ptans for proposed work • Draw to scale and note the fo!lowing as applicable: • Property Li�es .• Centurline of street • Outline end dimensions of all existin9 and • Indicete North pruposed structures on the lot • Show any proposed grading changes • Exlsting and proposed utilities • Show measurements PERMIT CONDITIONS t. All cells for Inapection shall be made 24 hra in advance - phone 258•8815. 2. Ail work shall be pe!formed in accordance witii this permit and current City of Everett Oesign end Cunstruction Standards and Specifications 3. Call Location Underground.Service 48 hra before you Aig. TOLL FREE NUMBER 1-800•424-5�55. 1 �L'LiCA�vT ��y �T�,� ,�,�,,��,� ,��,�,9TE m,q„iyo�� 7o t�sc�q.eG� P.��ssu�� Sro.�' S,�i✓�.e /tiro. �E.E' li�t'�ovFD PLnT PCA.�/, A� f-'�i2Driio_f.0 TyHr tor i(iG/G,1'o?�•¢ .�9��•eo�/,�S' Date Approvad as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everelt, WA 98201 Phone: 259-8P 15 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigr�ed owner/applicanl hereby agrees to hold ar.d save herm- less the City of Everett from any and all claims tor damages, cost& expenses, or causes of action that may a�ise because ot installetion and mainlenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. i � , ' a ]9/ Signature of pplicant Date WORK AUT ORIZED BY THIS PENMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERN;IT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.