5126 NARBECK AVE 2018-01-02 MF Import

Date 4/ �® Public Works Permit# afo—/�//3 / Application For BI pt.# ?W I OD7 0-0 PUBLIC WORKS PERMIT Public Works Fee Total Fee $ Less Appl.Fee Paid $ Print or Type Only Balance Due gi1e y PA//D, 5 'e E .64 78e73 34'7-ea Z S Owner J Mailing Address City Zip Phone Applicant Mailing Address City Zip Phone Describe Proposed Work /3/79erzz /5 aa00 Z i i2 /1 / 7 W Project Address(if known) Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable` mom • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE 0 PERMIT CONDITIONS 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. 2.All work shall be performed in accordance with 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. z e/G2i0424-2.-, 4e", 0 d c4/-r ®tee .- 0 a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- • less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation Z 7r7,- / 0 and maintenance of the improvement or other right-of-way use hereto Approved fo Cons tion Date applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. FINAL INSPECTION Date J ^// 7° Approved as Constructed Signature o App• nt Date everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO ell4 Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.