5314 33RD AVE W 2016-01-01 MF Import

Date �/Rf� � � Applicetion For PUBLIC WORKS PERMIT Print or Type Only �; i � S�; ,; oW�e� iOcJn �-Cd�LH Applicant Describe Proposed Work Project Address (if known) Address PUEIic WorW Permil �aj BICB. Deui. s d �T�� PUCIic Worka Fee Totel Fee S Leas AppL Fee Paltl S BalanceDue S Zip Phone Attach four (4) copies of plans for proposed work • Draw to scale and note the tollowing as applicable: • Property Lines • Centerline of street � Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls tor inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction Standards and Specificationa 3. Call Location Underground Service48 hrs. be(ore you dig. TOLL FREE NUMBER 1-800•424•5555. ,�f/,O�G.�,G/G: GG-�o.P�S� ��.�'I,7!% /PF'qG��E,O I Approved for Construction Date � FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259•8875 �r � /_8-B/a ACKNOWLEDGEAiENT OF CONDITIONS W H � � O � � � a The undersigned owner!applicant hereby agrees to hold and save harm- less the Ciry of Ever=L tro.^,: any and all claims for damages, costs, expenses, or cause; ot :ction ihat may arise because of installation and maintenance of the improvement or other right•of•way use hereto applied for and fuither agrees to remove same upon notice from the City and to replace public property damaged thereby. Signature of Applicant Uate WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIfHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.