1610 PUGET DR 2018-01-02 MF Import

Oate'/ T Application For PUBLIC WORKS PERMIT Print or Type Only Owner Mailing manmg Aaaress Describe Proposed Work Project Address (if known) Per blic Works Permit • 61d9 Dept • -�'✓ Pabhc Works Free S Total Fee Less �ppl. Fee Pslo $ — ^%) lr ealnnce Duo fi ZSd% - Lip Attach four W copies of plans for nroocved work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading 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 and Construction Standards and Specifications. 3. Call Location Underground Service 48 his. before you dig TOLL FREE NUMBER 1-800-424.5555. i " -�/? 7` / Approv llor Construction ate /00 FINAL IS�CTI� �.. Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 everett Cedar Street Everett, WA 98201 8201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS TT t cri Im 0 n z 0 0 a The undersigned owner/applicant hereby agrees to hold and save harm. less the City of Everett from any and all cla'utc for damages, costs. expenses, or causes of action that may ansB because of installation and maintenance of the improvement or oth: r right-of-way use hereto applied for and further agre la remo same upon notice from the City and r place public erty Ifag d thereby. r lgnatur pphcaN Dal WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.