9222 7TH AVE SE 2016-01-01 MF Import

� Date� '� � Application For PUBLIC WORKS PERMIT Print or Type Only Owner nnamng qdaress Describe Proposed Work `�''-� �1�-/ Proiect Address (if known) il� City ut�PCWonsPertril+ _ Bic,_Caot._ '��—�" �, I�:' Puolic Works Fea Totai Fee S Less ApO�. fee Pa�tl � Balanctl �ue $ c; C4' Attach four (4) copies of plans for proposed work - Draw to scale and note ihe following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities � Centerline of �trect • Indicate North • Show any Uroposed gratling r,hanges • Show measurements Phone PERMIT CONDITIONS 1. All calls M. !r.�paciion shall be made 24 hrs. in advance - phone 259-8815. z. All work shall be performed in accordance with this permi! and current Ciry of Everett Design and Constraction Standards and Speciticationa 3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. �UU'L /G GG�G.�'.�S ��^�// /%/U:` ��G� � Approved lor Consiruction Date FINA� INSPECTION D�:e Approved as Corctructed evcra;. PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Eveiett, WA 98201 Phone: 259�8815 7-Z-r?7 �� ACKNOWLEDGEMENT OF CONDITIOPIS Tlie undersigned owner/applicant hereby agrees to hold and save harm- less Ihe City ot Everett from any and all claims (cr damages, costs, expenses, or causes ot action that may arise because of installalion and maintenance ol the improvemam or other rigM�ohway use nereto applied for and further agrees to removo same upon nolice from the City and to replace public property damaged thereby. SignaWre ot Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIl"HIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGE�TLY PURSUED TO COMPLETION. THIS PERMIT ��1AY BE CAMCEI.L[D BY THE CITY UPON ANY STOPPAGE OF WOFK.ON THIS PROJFCT OVER 90 DAYS DURATION.