8527 9TH AVE SE 2016-01-01 MF Import

Date��jL' � Application For PUBLIC W�RKS PERMIT Print or Type Only ng ng Address City City Describe Proposed Work �� ( � � � ' �–R �—� L/ Prolecl Address (if known) Zip Zip Attach four (4) copies of plans for proposed work - Draw lo scale and note the following as applicable: • Property Lines • Outline and dimensions of all exis�ing and proposed structures on the lot • Existing and proposed utilities Public Wmks Per�yL J/,--�/-/-..�-.y.-/� 01tlg. Depl. +t �L c�f� �-I_` i Pubhc Works Fee Total Fee $ Less Appl Fee Paid $ Balance �uc $ • Centerline of slreet • Indicate N�rth • Show any proposed grading changes Y Show measurements PERMIT CONDITIONS t. All calls tor 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 Everetl Desi�n and Consiruction Standa�ds and Specifications. 3. Call Location Underground Service48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. �S//C/'�s ��/_S'Ty� c _%%i %! c= c'� �� �, �, j � ,��iC lC �'i �S �=��: ��i h'� ��'C�ii�l--U ��G � l Approved tor Construction Date FINAL INSPECTION Date Approved as Conslructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259-8815 ACKNOWLEDGEMENT OF CONDITIONS W H _ / The undersigned owner/applicant herehy agrees to hold and save harm- less ihe City ol Everett from any and all claims for damages, costs. expenses, or causes ol action that may arise because ol inslallation and maintenance ot the improvement or other righPof-way use here�o applied for and lurther agrees to remove same upon notice Irom ihe City and to repl2ce public property Gamaged ihereby. SignaWre ol P.pplicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DHYS OF DATE PERMIT IS ISSUED AND THENEAFTER IS TO BE DILIGENTLY F'URSUED TO COMPLETION. THIS PERMIT A1AY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.