2107 33RD ST 2016-01-01 MF Import

D'atB�LO U � � , Application For PUBLIC WORKS PERMIT Print or Type Only PuOLtWorksFer ' a ( Blag. Oepi. + � Public Works Fee $ Tolal Fce Less Appl. Fee PaiO $ Balance Due $ Applicant Describe Proposed Work Project Address (if known) cuy Attach four (4) copies ot plans for proposed work - Draw to scale and note ihe following as applicable: • Property Lines • Outline and dimensions of all existing and proposed sVuctures on the lot • Existing and proposed utilities i Centerline of street • Ir,dicate Nor�h • Show any proposed grading changes • Snow measuremenis Phone PERMIT CONDITIONS 1. All calls for inspection shall be ma�ie 24 hrs. in advance • phone 259•F381 O. 2. All work shall be pedormed in accordance with this permit and current Ci�q�ot Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424•5555. Approved (or Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street cverett, WA 98201 Phone:259�8810 _- 9 2�-a� ACKNOWLEDGEMENT OF CONDITIONS W � � The undersigned owner/applicant hereby ayrees to hold and save harm- less the City of C-veret� from any and all claims for damages, cosls, expenses, or causes of action that may arise because of installation and maintenance of lhe improvemenl or other right-of-way use herero applied lor and further agrees to remove same upon �iotice Irom Ihe City and to replace public property damaged thereby. Signalure of Applicant Date WORK AUTfiORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMI7 IS ISSUED AND THFREAFTEFi IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS °ERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE C1F INORK ON THIS PFOJECT OVER 90 DAYS DURATION.