1630 PUGET DR 2016-01-01 MF Import

Date A��plication For PUBLIC W�ORKS Print or Type Only �330 Mailing Describe Proposed Work , Prpject Address (if known�� _'[� � P�MIT O O a �u 'o '��' r+ r� ai �i M ^ W W lJ� 41 F — aa os � h �t � W PuOiic Works Permil � __� � BIJg Dept • � Pu�li� Work1 Fee Totnl Fee S �� Less Appl Fee Paia s� � Baiance Due S _TT'T / — Attach four (4) copies of plans fo� proposed work - Draw to scale and nole the following as applicable: • Proparty Lines � Centerline of sireet • Outline and dimensions of all existing and • Indicate North proposed structure, on the lot • Show an • Existing and propo;ed utilities Y P[n�osed grading changes • Show measuremeits PERMIT CONOITIC NS 7. All calls tor inspection shall be made 2a hrs. in advance • phone 259•881 O. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Stendards and ��pecifications. 3. Call Location Underground Service 48 hrs. before you tlig. TOLL FREE NUMBER 1-$OO•qQ4•5555. .�, ��Pr // rcv.e�� c�ts ciL�� 8 /J�'i .� GtJa d�i- y�,�r �� a,�-�- ,i'3�,�r� B� �p � u.st- .�uz ! /l.s�y/ffd� / �-zfj,...� �.��. / lr��.t�. LC' Approved as Constructed everett PUBIIC WORKS DEPAqTMENT � 3200 Cedar Street Everetl, WA 98201 Phone: 25� �810 Date W � � � � � O a ACKNOWLEDGEMENT OF CONDITIONS The undersic�ned owner/applicanl hereby agrees to hold and save harm- less Ihe City of Everett Irom any and all claims lor tlamages, costs, ezpenses. or causes of action that may arise because of installation and maintenance of the improvemenl or other right-of-way iise hereto applied lor and lurther agrees to remove same upon notice Irom Ihe City and to replace public property damaged thereby. , '( T�—�.�\ O�U�� Signature of Applicant �% pa�e WORK AUTHORIZED BY THIS PERMIT MUST BE S..>RTED WITH�N 190 DAYS OF �ATE P[RMIT IS ISSUEC AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLET�ON. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.