3235 52ND PL SW 2016-01-01 MF Import

Date� �� >"� �1 Application For PUBLIC WORKS PERMIT Print or Type Only �b�J� CiI�Y Publ¢ WOMs Penn�i� y BIa9. UeOt • �'S � C.� \ Pu�hc Woiks Fee To1al Fee $ Less ApO�- Fee Peia $ Balance Due 2 Applicant Mailing Address City Zip Phone Describe Proposed Work Proiect Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Ezisting and proposed u�ilities • Centerline of street • Indicafe Nor�h • Show any proposed grading 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 performed in accordance with this permit and cu�rent City of Everett Design and Construclion Standards and Specitications. 3. Call Location Underground Service 48 hrs. be(ora you dig. TOLL FREE NUMBER 1-800•424•5555. /�u�� .��-� �/�,��, Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBI.IC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259-8810 ACKNOWLEDGEMENT UF CONDITIONS � O The undersigned owner/applicaM hereby agrees to hold and save harm- less the Cily ol Everett from any and all claims for damages, costs. �� expenses. or causes of action that may arise because of installation �. and maintenance of ihe improvement or other right-of-way use heretu � � applied for and further zgrees lo remove same upon notice Irom the � City and to replace public properry damaged thereby. � Signature of Applicant Dale I�� WORK AUTHCRIZED BY THIS PERMIT MUST BE STARTED WITHIN � 180 DAYS GF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE PILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIO�J.