5507 25TH AVE W 2016-01-01 MF Import

� Gross T�fF q o !,� Public Wo�ks Permit• Date"1 _ BICg.DeO��• Application For PUBLIC WORKS PERMIT PubT°WF9aFeB s LesS ApPI.Fee Paid $===-I/� Balance Due S ! PrintorTypeOnly �� POSTING �'� �gs � ��- � ��G�/ Phone Owner Mailing Address City Z�P Applicant Mailing Address City Zip Phone (v � �irr�e.wi'tiq �cs �e►� .��q'avtid � ati Describe Proposed Work � W��G ' � —�� st _ W Project Address(if known) _ s� � a'�r" " �� � Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � • Property Lines • Centerline of sireet • Outline and dimensions of all existing and • Indicate North ,roposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements M W DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8$10. 2.All wor.shall be performed in accordance with this permit and current Ciry of Everetl Design and Construction Standards and Specilications. � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•B00•424-5555. O � � O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm� less the Cily of Everet� from any and all claims for damages, costs, � expenses. or causes of action ihat may arise because of installation . .a maintenance of the improvement or other right-of-way use hereto �� pplied tor and furiher agrees to remove same upon notice irom the Approved J. C� ��;o ,��1e� Ciry and to replace public property damaged thereby. C / i �, , -, 7- l f _ C�P � � �. .P �� FINAL INSPEC ON Date Date Approved as Conctructed Signature of Applicant PUBLIC WORKS DEPARTMENT 80RDAYS OF DATE PERMIT ISESSUED ANDBTHEREAFTER IS TO 9200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Everett WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259•8810 PROJECT OVER 90 DAYS DURATION. �