620 34TH ST 2016-01-01 MF Import

Date�� Application For PUBLIC WURKS PERMIT Print or Type Only P�pO[ Works Formit s / BItl9. Dept • Public Works FCo iolal Fea S Less Appl. Fue Paitl 5 — Balance Duo D Phone �'31i'Ylf�' Applicant Mailing Address City ZiN Phone Describe Proposed Work Proiect Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note ihe following as applicable: • Property Lines • Centerline of street • Outtine and dirt�ensions of all existing and • Indicate Norih proposed structures on ihe lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS t. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shall'�� performed in accordance with ihi, permit and current City of Everett Design and Construction Standards and �pecifications. 3. Call Lccation Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800-424-5555. ��BG�C GLIG�/��S �,c�� .ti�: ��Gi.c'�.c7 Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everet[ PUBLIC WORKS DEPARTMENT � 320Q Cedar Street Evere�t, WA 98201 Phone: 259-8815 8��8 7 'J'"'. �i ACKNOWLEDGEMENT OF CONDITIONS W F- � Z'I O � �� � O � The undersi�ned owner/applicant hereby agrees to hold and save harm- less the City of Everett Irom any and all claims for damages, costs, expenses, or cause& of action that may arise because uf installation and maintenance ol the improvement or olher right-o4way use nerelo applied for and turther agrees to remove same upon notice from the City and to replace public properry damaged therehy. Signalure of Applicant ua�e WORK AUTHORIZED BY TH�S PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO BE DILIGENTLV PUR,",UED TO COMPLETION. THIS PEflMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.