710 PECKS DR 2016-01-01 MF Import

Date_._s�� % �_' _ —� � Pu�l¢WorksPermll�� B�C9�OoO�� Application For PUBLIC WORKS PERMIT PUbTollFaoFae s LessApO� FanPeitl S Oalance Our S Print or Type Only 1VVV/►►► III\/1�_1'� , P ,,�.,,�;4�.. �C� ��ef MaJing Atldress Cdy Lp Phon V ,�..-: `�/� �.� ��— — Applicant MaJing Addre55 City Zip Phone Describe Proposed Work �'`�~ �"�— � " � W Pro�ect Address pl known) _ / � ' � Attech four(4) copies of plans lor proposed work• Draw to scale and note the tollowing as applicable: �f . • Property Lines • Centerline ol street � • Outline and dimensions of all existing and • Indicate North proposed structures on the lot � Show any proposed grading changes • Existing 0nd proposed utilities • Show measuremenis � 00 NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for in�pection shall 6e made 24 hra in advance-phone 259•8815. � 2. All work shell be pertormed in accordance with this permit and current City of Everett Design and Construction Standerils and Specifications 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•S00•424•5555. � C� � ��:�ii it/oT .�E�yUr�E.O PE•e ,S�?DOI�'.S. � � � O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm• Iess the City of Everett Irom any and all claims lor dama�es costs. e■penses, or causes ot action that m�y arise br.cause of instaltation and maintenance o1 the 'mprovemenl or other righl•ol�way use hereto applied lor and lurther agrees to remove same upon notice Irom the Approved lor Construction Da�e Cily and to replace public property damaged thereby. F�NAL INSPECTION Date Approved as Consiructed Signature o�Applicant Date ��ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN everett PUBL�C WOFKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE Evcrett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOHK ON THIS Phone:259�8815 pROJECT CVER 90 DAYS DURATION.