8201 BEVERLY LN 2016-01-01 MF Import

Application For PUB�LIC WORKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Sireet Everell, WA 98201 (425) 257-8810 Date '� � Z Public Works Permit A Building Pertnit p _ 9� � �q i �s TYPE OR PRINT ONLY Public Works Fee $�� t�K Tcl weJ�- lnc,_ 22ozs � �t.�e Bo�l1—`i� � ��s-39� �179 Owner Mailing Atltlress City Zip Phone Describe Proposed Work � + 63� PROJECT ADDRF.SS (il known) _��b� g �Vtr`v �,.`n y�� Attach lour (4) copies plans for proposed woik - Draw to swle and noto the lollowing if applicablo: • Proporty :.ines • Outline end dimonsions ol all ozisting and proposad slructuros on Iho lot • Existing and pioposetl utilities • Contedine ol street • Indicale North • Show any proposad gratling changes • Show moasurements DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS: 1. All calls lor inspection shall be made 24 hours in advance - phone (425) 257-8810 2. All work shall be perlormed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. . 3. Cali Lxation Underground Sen�ice 48 hrs. belore you oig. TOLL FREE NUMBER 1-800-42q-5555. W H - � � O � V / O a ACKNOWLEDGEMENT OF CONDITIONS Tho undersignnd owner/applicant horeby agrees lo hold antl save harmless the Ciry o! _voretl Irom any and all claims fur damages, costs, ezpenses, or causes :,i acdon thal may anse because ot inslallation and maintenance ol the improvement or other right�of•way use horolo applied for and further agreos to remove sama upon notice irom tho Ciry antl to replace public propo�ty dam- aged thora ly. ,ngn re o n a a �� WORK AUIHORIZEO BY'fHIS PERMR A1UST BE �'TAFiTED WfTHIN 1B0 OAYS OF DAT}: PERMfT IS ISSUED AND T}IE R IS TO BE DIUGENT�Y PURSUED TO COM%FfION. THIS PERMR MAY BE CANCELLED BY THE CRY UPON ANY STOPAAGE OF KqHK ON h{IS PRQIECT OVER 90 DAY'S WFiAT10P1.