913 33RD ST B 2016-01-01 MF Import

Date L� �� ppplication For PUBLIC WORKS PERMIT Print or Type Only �j ! 3 � 3J'"� s/ _ Mailing Describe Proposed Work /00 �` Zip Zip PUEIic Worke Vermit s emc. o«u�. + — Public Work6 Fee s � �7 Tot�' Fae Lens ApO� Fee PaiO S Belence Due S -2�6 Project Address pf known) "` �- � ti T' Attach four (4) copies of plans for proposed work - Draw to scale and note Ihe following as apPlicable: +J • Property Lines • Outline ar�;i dimensions of all existing and proposed struclures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PEP.MIT CONDITIONS t. All calls for inspection shall be made 24 hrs. in advance - Phone 259•881 5. 2. All work shali be peAormed in accordance with ihis permit and current City of Everett Design and Construction Standards and Specification�. 3. Calf Localion Underground Service 48 hrs. 6efore you dig. TOLL FfiEE NUMBER 1•800-424•5555. �/ l�� / c � ��A �, D �� - � �� Approved for Construction Dale FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 � � ACKNOWLEDGEMENT OF CONDITIONS W H � � � O F- � O a The undersignr.d owner/applicant hereby agrees to hold and _ave harm- less the City ol Everett irom any and all claims for damages, costs, expenses, or causes ot action lhat may arise because ot installation and maintenance ot Ihe improvement or other right-ol�way use hereto applied lor and lurther agrees to remove same upon notice Irom ihe Ciry and lo replace pu6lic properry damaged thereby. Signature ol ApplicaN Date BORDA'fSTOO DATE� PERMIT SESSUED ANDBTHEFEAFTER IS TIO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON THIS PROJECT OVER 50 DAYS DURATION.