1611 EVERETT AVE 2016-01-01 MF Import

^1 I —�:r�.�a---�R_��_"„ � ._ ..____ ._—�—__._.,.---..��.'.� -'.�..�v. . ' . i _- .�T�`T�— . . . . . , � �� � /� � � i —.Y— �yC� �'vobc worAe Ge�j� _ � Date eiep.oeoi.+ , -� Application For ' PUBLIC WORKS PERMIT PueTatrieeFce $ , � Lesf ApO��Fce Pm0 5 Iomencv Oue 5 � x�� Print or Type Only ft� � 'L c�H < . . �-.r-� � i-� � �-� �� ; � -'� „� 'ilF 1/� l l ,~'� Yr�� / )tF � , ,/� �Tf , r�-�i� ay�n �1 P !� rt � � � � I � u�� ,� H � i Mading Address Cdy LP Phone Owner i O xO ' �q y H � Applicant Mailing Address Ciry Zip Phone � �� '/ ,� _ DescribeProPoSedWork ��x~�� r � �� :y� �11 1�'/� �� ' �� H � � �g ,,, _ 4�� C� T � � y� �, s- - -- — '... p.�y Project AGdress(i1 knewn) �- � � H Attach four(4)�:opies ol plar,s b�Groposed work�Draw to scale and note Ihe lollo��.ing as 3pplicable. O l7 f/� ' • Cenlerline ol slruet r^ q q • Property Lines 3 [•1 t" i • Outline and dimensions of all existing and • Indicate North Y/ : • Show any proposed c�rading changes proposed structures on Ihe lot � $how measurements /1A y p y '. • Erisling arid proposed utililies � ; DO NOT WRITE BELOW THIS LIIJE � �� PERMITCONDIiIONS �, 7.All calls for inspection shall be made 24 hrs.in advan[e-phone 259•8870. � � 2.All work shall be pedormed in accordance wilh Ihis permil anu current City ol Everelt Design and Conslruction � �I Stand.rdsandSpecitications. ` '+. .,�I 3.Call Location Underground Service 48 hrs.before you Cig.TOLL FREE NUMBER 1•800•424•5555. � i ~ ` I N � �_`v`.� cJ \Vc i[._rL•_ '-tL`�t � i' �—�_ . _, i CLt 7 O ''�' �"� I I -LG_...� 6� 1�-ILc�_. �! li II - - �-'��`-� '�^ � '� r. , - ------- �// �� O I'" I' a _... �i '.'� �� ACKNOWLEDGEMENT OF CONOITIONS i The undersigned owner/applicant hereby agrees to hold and save harm� ! less ihe Ciry ol Everett Irom any and all claims lor damages. costs. '� I eapenses, or causes ol action that may arise because ol msla ation `�`�. I and maintenance ol Ihe improvem�nt or other right�of�v:ay use hereto iapplied for and turiher agrees to remove same upon notice Irom lhe � Approved tor Construction Date City and to replace pubGc propeily damaged thereby. � �� FINAL INSPECiION Date Date Approved as Constructed Signalure ol Applicant �I WORK AUTHORIZED BY THIS PERMIT UUST OE STARTED WITHIN everett PUBLIC WORKS DEPAR7MENT 180 DAYS OF �ATE PERM1IIT IS iSSUED AND THEREAfTEM IS TO 3200CedarS�ree1 BE DILIGENTLY PU�SUED TO COMPLETION. THIS PERMIT MAY B[ Everett,WA 9020i CANC[LLED 0Y THE GITY UPON ANY STOPPAGE OF WORK ON THIS I e phone:259�8810 pROJECT OVER 9J DAYS �URATION.