1606 PUGET DR 2016-01-01 MF Import

.. - - :1.'� Application For PUBLIC WORKS PERMIT Print or Type On�y Maihng mau uy nuwcaa Describe Proposed Work Proiect Address lif knownl Publ¢ WO�Ms Pa�mp • L1 � 01�9 Dno� � � � _ , Publi� Woi�s Fee Tolaliee S � LeSs Anol Fae Paia S �atanw �ue S 2� 33�-0�/7 Phone ��v uP Phone Attach four 14) copies of plans for proposed work - Draw to scale and note the IoPowing , s applicable: • Property Lines • Oulline and dimensions of all existing and proposetl structures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any propOsed gratling changes • Show measurements PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design end Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBF.H 1-$pQ-4Q4•5555. �io��'-i /2 hf1VAL INSPEGTION � � — / Approved as Conshucted everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259•8810 Date ACKNOWLEDGEMENT OF CONDITIONS W � � The undersigned owner/applicant hereby agrees to hold and save harm� less the Clty of Everetl Irom any and all claims for damages, costs. ezpenses, or causes of action Ihat may arise because of installation and maintenance oi ihe improvement or other righl•ol•way use heretu applied lor and lurther agrees to remove same upon notice from ihe City and to replace publlc property damaged thereby. ��-�� l-aQ- �9 Signature ol�, ppllcant —� Dale WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUEC TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 D�iYS DURATION.