3005 52ND PL SW 2016-01-01 MF Import

Date.��.LD� Applica�ion For PUBLlC WORKS PERMIT Print or Type Only Owner ng Pubhc Worhs Pcrmn v �-/ v/ �/ BId� DeO�� • Poplm Ylorks Fee $ TOIOI Fec Less Appl Fec Paid $ �j Balancc Due S `� City Zip Phone Applicant Mailing Address City Zip Phone Describe Proposed Work ��`��`�� Prolect Address (it known) Al'ach four (4) cupies of plans for proposed work - Draw to scale and note the following as applicabie: • Properry Lines • Outline and dimensions of all existing and proposed shuclures on the lot • Existing and pro,�osed utilities l�y • Centerline of street • Indicate North • Show any proposed c,rading changes • Show measurements PERMIT CONDITIONS 1. All calis for inspection shall be made 24 hrs. in advance - phone 259•8810. 2. All work shall be pedormed in accordance with this permit and current City ot Everetl Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. Approved as Constructed everetl PUBLIC WORKS DEPARTMENT � 3200 CedarStreet Everett, WA 98201 Phone:259�8810 GO Date y"j�.�� Date 11CKNC�WLEDGEMENT OF CONDITIONS W H � � O � � O a The undersigned ownedapplicaN hereby agrees to hold and save harm� less ihe City of Everett irom any and all claims lor d2mages, cosls, expenses, or causes of action ihaf may arise because of installation and maintenance ol the improvement or other right-of-way use hereto applied for and furtlier agrees to remove same upon notice from the City and to replace pu6lic property damaged thereby. l� � � 1 f�.� ��3-��' SignaWre ot Applicant Date N'ORK AUTIIORIZE� BY THIS PERMIT MUST bE STARTED WITHIN 180 DAYS OF DATF PERMIT IS ISSU[D AND THEREAFTER IS TO BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAY BF CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.