1709 PUGET DR B 2016-01-01 MF Import

Date�L� 7 APP��wtion For PUBLIC WORKS PERMIT Print or Type Only Gny Describa Proposed Work � ytl Pwiect Address (if known) f J v z � — ' - Attach four (4) copies of plans for proposed work- Oraw to scale and note lhe lol�owing as applicable: • Property Lines • Outline and dimensions ol all ezisting and proposed strutturos on the lot • Ezisling and proposed utilities PERMIT CONDITIOkS Pu411c Warks Permll s f�7•� 215 aiee. oeoi. + $ ]�� S Pu�lit Works Foe Totnl Fee S _ Loss AOP� Fen Paltl S an Belance Ouo S �� � • Centerlire of street • Indicate North • Show any proposed greding �hanges • Show measuremenis i. All calls for inspoction shall be made 24 hrs in advance • phone 259•881 5. 2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction Standards and Specilications 3. Call Location Underground Service 4B hrs. be(ore you dig. TOLL FREE NUMBER 1•800•424•5555. �{, �i.)srqu. l�'�/ul��[S Fu',e, .f'�F_ ToP �t�. �.�j � oa� ��0/'7 Approve Constru ion o„ � Date ��/%%% ��JJJ///%yy- / AL SPEC�� Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everelt, WA 98201 Phone: 259•8815 ��,rJsr�vurS ACKNOWLEDGEMENT OF CONDITIONS W H � The undersigned ov.�ner/applicant hereby agrees to hold and save harm• less the City of Everelt from any and :dl claims for damages, costs, expenses, or cause of action that may arise because of instaliation d maintenance o t improvement or other right-ol-way use hereto pp' for and f h rees to remooe same upon notice from the 'ly a to repl c 'c roperty dnmaged thereby. \ _ � Signature of App!'c3nt Date WORK AUTHJRIZFD BY 1HIS PERMIT MUST BE STARTED WITHIN 100 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS FE�MIT MAY BE CANCELLED BY TI IE CITY UPON ANY STOPPAGE OF �'J'�RK ON THIS PROJECT OVER 90 DAYS DURATION.