1213 21ST ST 2016-01-01 MF Import

� Date � 3 Applica�ion For PUBLIC WORKS PERMIT Print or Type Only �-�7 � Owner � J Aoplicant Mailing f� .�/ Pu01ic Wode PBrpmit �•/ A ��—y BId9. OaPI. s / T A �� Publit Works Fae 9� Totel Fea s � Lees ApO� Fee Paid s �1 6olence Due S /� Zip ��5� / / Pho�ne G �//'/ �/� City Zip Phone Describe Proposed Work 'vv " J ��j� G�'v��r/~/`��' Project Add�ess (if known) Attach four (4) copies of plans for propose�J work • Dr.;w to scale and note the folloviing as applicable: • Properry Lines • Centerline of street • Outline and dimensions of ali existing and • Indicate North proposed structures on the lat • Show any prcposed grading changes • Existing antl proFosed utilities • Show measurements PEFMIT CONDITIr�NS 1. A!I cnlls for 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 of Everett Design and Consiruction Standarda and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. `T ,��✓ � /�ii1S for q� ic�i-0 CY /� � /' [,d ^ / /� �'f' /� �� �yU `�P'� a 9 � '� �P" r„ ;s� �J� �`� �� ' s �i � G'� �Pf/f / �v _ /' everet! PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WP�. 98201 �� Phone:259•8875 4 �� O'� � i —7.� —b"6 Date /1�� AC N DGEA1ENT OF CONDITIONS The undeisigned owrer/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-oF-way use I±ereto applied for and further agrees to remove same upon notice Irom the City and to repl E-P blic perty damaged thereby. /`� G /� � S e Applicant ie WO AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT t�1AY BE CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.