5034 33RD AVE W 2016-01-01 MF Import

. . - 1-�� .� Application For PUBLIC WORKS Print or Type Only �'� owner �-�ti o ,� C Applicant Describe Proposed Work _ Project Address (if known) _ Attach four (4) copies oF plans for proposed work - Draw to scale and note the (ollowing as applicable: • Property Lines • Outline and dimensions ot all existing and pro4osed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS ¢ WoiAs Perm�it / / �r ap.oeot• (�T /�V uUl:c \vorks Fee Tmal Fee S Less ApDL Fee Paitl $ Baiance Duc S • Centerline of siree� • Indicate North • Show any proposed gradiny changes • Show measurements 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be pr.rformed in accordance with this permit and cur. =N Ciry ol Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. belore you dig. 70LL FREE NUMBER 1•800-424•5555. %�U/�G/C Gtia.�'.�5' �r.�i��-% %/OT rC'��qlii��.O �Z/�9L �'�� Approved for Construction Date FINAL INSPECTION Date Approved as Construc�ed everett PUB�IC WORKS DEPARTMENT � 3200 Cedar Street Evarelt, WA 98201 Phone:259�8815 - a ood ACKNOWi �DGEMENT OF CONDITIOi!S W H � � O � � � a The undersigned owner/applicanl hereby agrees to hold and sav? harm- less Ihe City ol Everett trom any and all claims for da�nages, cos's, expenses, or causes of aclion that may arise because ot installation and maintenance of the imarovement or other right-of•way cse hereto applied lor and lurther agrees to remove same up�n no�ice'rom ihe City and to replace public property damaged thereby. Signature oi Applicant Date WOIiK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. TH13 PERMIT MAY BE CANCELLED B'/ THE CITY UPON ANY STOPPAGE OF WORK ON TH'�S PROJECT OVER 30 DAYS DURATION.