1726 PUGET DR 2016-01-01 MF Import

Date�-� Application For PUQLIC WORKS PERMIT Print or Type Only Pu01ic Woiks Permlt • ✓ `� _ �� BItlQ. Oepi. + Pu01ic Wo�ka Fea Tatel Fee s �esa Appl Fee PeIE S Belance Uue � � �,/ f�97JC'llT� Applicent Mailing AdAress City Zip Phone Describe Proposed Work �� hT�L>� ��-a�P (J��k1 `1r Project Address (if known) Attach four!4) copies of ptens for proposed work • Drew to scale and note the following as applicable: • Property Lines • Out�ine and dimensions of all existing and proposed structures on the lot • Existlng and proposed utilities • Centerline of street • In�ficate North • Show any proposed grading changes • Show measuraments PERMIT CONDITIONS 1. All cails for inspection shell be made 24 hrs. in advance - phone 259•881 5. 2. AII work shell be performed in accordance with this permit and curreiit City ol Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. �/%.�> .l�Jn. r�.� % �.s�- 9S Approved lOr Consiruclion Date \yCY-'�i �.2�M+�'-� . � � I� / .E� FINAL INSPECTION Date Approved as Constru�ted everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259•8815 ACKNOWLEDGEMENT OF CONDITIONS W � � � O � � O a The undersi��ed owner/applicant hereby agrees to hold and sava hann- less the City of Everett from any and all claims br damages, costs, expenses, or causes ol action that may arise 6ecause ol instal�ation and maintenance ol Ihe improvement or other right�oi•way use hereto a{�plied tor and further o�rees to remove same upon notice Irom lhe City and to replace public property damaged thereby. i �� , /G 5� �, Si nature IAppl-' nt Dale VJORK AUTHORIZED Y THIS PERMIT MUST BE STti�?TED WITHIN 180 DAYS OF DATE PERAIIT IS ISSUED AND THEREArTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. � �