1626 PUGET DR 2016-01-01 MF Import

Date v/.Fl,tq /' [ Application For PUBLIC WORKS PEG�MIT Print or Type Only Lp Pubhc Wo,Ys Permit . _ �� _ ein� oeoi • _��p��Q�-- P�Nbc Wo�W Fce TO�PIFP.P S � Less ApPI Fee PaiO $ Oalance Due s �� Sa�p _ Applicant Mailing Address City Lp Phone . - ... . . . � . ' - .i .. ri . .. �. Project Address (if known) _ �'� "'� vc c i Y Attach four (4) copies of plans lor proposed work • D;aw lo scale and not2 the tollowing as applicabla: • PrOperry Lines • Outline and dimensions of all existing and proposetl structures on the Iot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls tor inspection shall be made 24 hrs. in advance • phone 259•881 �J. 2. All wark shell be peAormed in accordance with this permit and current G�ty of E:erett Design and Construction Standards and Specificatione. 3. Call Locetion Undergrountl Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. S�/ ) "e �i'-?[;'�'l � �'(�� .��Z' �11�.'"'GLL�� �t''C.2c.r �-(., , �`�, everetl PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 25B�fJB10 ACKNOWLEDGEMENT OF CONDITIONS W H � Z O: � � O a The undersigned owner/applicant here�y agrees to hold and save harm- Iess the Cily ol Everett Irom any and all claims for damages. costs, e■penses, or causes ot action that may arise because of installalion and maintenance of the improvemenl o� olher right•ol•way use hereto applied lor and lurther agr^=� to remove same upon notice Irom the Ciry and to repl�e publ-c prope�ly damaged thereby. „� (4r.cq.s� �� : i9 aWre f PP�� ate WORK AUTHOR ZED BY THIS PERMIT MUST BE STARTEO WITHIN 180 DAYS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELIED BY THE CITY UPON ANY STOPPAGC OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.