10127 9TH AVE W 2016-01-01 MF Import

Date Application For PUBLIC VIf��RKS PERMIT ^rint or Type Only �� Mailing Describe Proposed Work Project Address (if known) � ,ly .a Yy � ¢ O O O � � o .-� o a *-+ rU r•� w «' ciry� � � � = zip 61 O 3 V� ��r�, I,�,�� City Zip Public Warke Permit s lK/ / aiea� oeu� r PuElic V:orha Fee 7olal Fee $ -- Lav ApPI Fee PaiE $ ��._, Balanca0ue $ �� ZOIZ Phone �� Zoiz Phone ��- Attach (our (4) copies of plans for proposed work - Draw to scale and note the tollowing as applicable: • Property Lines • Centcrline of sireet • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cali Location Underground Service 4A hrs. betore you dic�. TOLL FREE NUMBER 1-$00•424-5555. a� P� -�. �J�'+�t � `u -� �y.� of P�,�- �, �t� Z- FINAL INSPECTION Approved as Constructed � PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259•0810 Date Date ACKNOWLEDGEMENT OF CONDITIONS � � l�ne �ndersigned owner/applicant hereby agrees to hold and save harm- less the City ol Ev=rett from any and all claims tor damages, costs, expenses, or causes o( action that may arise because of installation and mainlenance of lhe improvement'or other right-ot�way use hereto ' applied for and furiher agrees to remove same upon nolice from the Ciry and to repla public properry damaged thereby. ig ature f plic t Date 6NORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1II0 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS �TO BE DILIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAV BE CANCELLED BY THE CITY UPON ANY STUPPAGE OF WOfiK ON'lHIS P(70JECT OVER 90 DAYS DURATION.