10709 9TH DR SE 2016-01-01 MF Import

_r � - - �` -- � Application For PUBLIC WORKS PERMIT Print or Type Only 9- iT�`�t.fc 55 c�iY Public Works Per • Bleg. Oept � � / �� Pubbc WOMs Fec Tolal Fee 5 luss AOOL Fee Paid S Balance Due 5 � �sJ = �� Zip Phone ��Y Zip Phone Describe Proposed Work �«%�� Prolecl Address (if known) A�tach (�mr (4) copies of plans for proposed work - Draw �o scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed siructures on ihe lot • Existing and proposed utilities PERMIT CONDITIONS • Centerline of siree� • Indicate Nor�h • Show any proposed grading changes O Show measuremenis 1. All calls (or 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 ot EvereL Design and Construction Standards and Specifications. 3. Call Location Undergruund Service 4d hrs. before you dig. TULL FREE NUMBER 1-800-424-5555. �vo'�iG ✓�o,e,�-r �`�E,�r.�ii �oT .Pfc�v�2l-.0 Approved for Construc�ion FINAL INSPECTION Approved as Constructed � everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Slreet Everetl, WP. 98207 Phone:259�8875 Date Date �=i�Goll/ `3/9//d6 AGKNOWLEDGEMENT OF CONDITIONS � � The undersigned owner/applicant hereby agrees to hold and save harm� less the City of Everett Irom any and all claims for damages, costs, ezpenses, or causes of action that may uise because of installation and maintenance of ihe improvement or c;ner right-ohway use hereto applied for and furlher agrees to r=move same upon notice Irom the City and to replace public property damaged Ihereby. Signature ol Applicant Date WORK AUTHOkIZED BY THIS PERMIT MUS7 BE STARI'ED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERAIIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI;; PROJEC? OVER 90 DAYS DURF,TION.