10222 9TH AVE W 2016-01-01 MF Import

Date � � Application For P�l�LiC WORKS PERMIT Print or Type Only �.�d��y „��e�� Mailing Address Descri6e Proposed Work Project Address (if known) _� �� — ary Lip City Zip 7 � � , . _�� w7�t..� .L..n.... Attach four (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: • Property Lines • Outline and dimensions of all existiny and proposed structures on ihe lot • Existing and proposed utilities PEflM1T CCNDITIONS Publm Works Pe mit a eiae.00P�.. � � _3 7.� Pubhc Works Fee Totai Fea � LessApO�� Fce Palp S Balanco D�a $ • Cenlerline o( street • Indicata Nor�h • Show a,iy proposed grading changes • Show measuremenis Phone 1. All calls lor inspection shall be made 2a hrs. in advance - phone 259•881 5. 2. All work shall 6e perlormed in accordance with this permit and current Ciry ot Everett Design and Conslruction Slandards and Specifications. 3. Call Location Underground Szrvice 48 hrs. helore you dig. TOLL FREE NUMBER 1-800•424-5555. PL/�G"/G GUV��s' f�f,�/�;�T /VoT ,C'FlaUi2F.0 Approved for Consiructicn FINAL INSPECTION Approved as Consiructed evere�t PUBLIC WORKS DEPARTMENT � 3200 Cedar Street L-verett, VJA 98207 Phone:259�8015 Date Date /� j�G /� �/ ACKNOWLEDGEMENT OF CONDITIONS W � M/ � � The undersigned owner/applicant hereby agrees to hold and save harm� less the City of Everett from any and all daims for damages, costs, expenses, or causes ol action that may arise because of installation and maintenance ol lhe improvement or other right-ol-way use hereto applied for and further agrees to remove same upon no�ice irom ihe Cily and to replar : public properry damaged thereby. Siynature of Appiican� Date WORK AUTHORIZED BY THIS PERMIT MUST BE S�lARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETIO�!. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DA"5 DURATION.