1709 PUGET DR 2016-01-01 MF Import

Date�3L�� 7 Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address Describe Proposed Work Prolect Address (il known) Ciry Zip Public Works Permi—1 .y ��-/ �/� G/ J BIdg.Depl.+ p.��,.i�� Pu�lit Works Fce g Ta1nlFeo LoSs Appl Feo PaiO $ Balancu Duo $ a0 UU �F Attach lour (4) copies ot plans for proposed work - Draw to scale and note the lollowing as applicable: • Property Lines • Centerline of slreet • Outline and dimensions ot all existing and • Indicate North proposed structures on the lot • Show any proposed grading channes • Existing and proposed utilities • Show measurements Phone PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shal� be performed in accordance wilh this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. �, .Ii.JSrq�c l��,.��/ic.l�Gcs Fi�, i('ch�F- 7c�P i��ro',clSt'vu75 everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Slreet Everett, WA 96201 Phone:259�8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � O � � O a The undersigned owner/applicant here6y ayrees to hold and save harm- less ihe City of Everett from any and all claims for damages, costs, expenses, or caus ot aclion lhat may arise because of installation d mamtenance of t improvemeN or olher right-ol-way use herero �pp � tor and t�clh �ees to remove same upon nolice Irom the iry a to repl�ce�i c roperly damaged thereby. WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.