1110 MAPLE ST 2016-01-01 MF Import

!� �i _2�7_� ` / �a�e "_/�y/�� PuElicWorksPermil�� J� — .. --T—f Applicution For ema.ner�.._�` 5 PUBLIC WORKS PERMIT P�OToteFeeFee � Lefe�p0�Fae Paid ��— B81011CBDU0 S �'�OO s Print or Type Only � _ .r l�a G� � ' �Zsa/N�` Owner Mailing Address Cily Zip Phone A G R�„�t�e l�l s3o �- i39 tti ��e Se ��o.��,r., � 98a9� 5��8- 53�� Applfcant Mailing Address City Zip Phone Deacribe Proposed Work CNYI c ��P i' � ��i / e j`I!`�e��Q _ ! W Pro�ect Address�if known) ��G m6.�,��p � Attach tour(4)copies of plans lor proposed work- Draw to scale and note the lollowing as applicable: � • Property Lines • Centerline of street � • Outline and dimensions of a�i existing and • Indicate North proposed structures on the lot • Shov. any proposed grading changes • Exi3ting end proposed utililies • Show measurements � DO NOT WRITE BELOW THIS LINE O PERMIT COhDITIONS 1. All cells fo� inspection shell be made 24 hrs. in advance• phone 259•881 5. � 2. All work shell be peAormed in accordence with this permit and current City of Everett Design and Construction Standerda end Specifications. 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424-5555. � O � � O a ACKNOWLEDGEMENT OF CONDITIONS �(.� 7he undersigned owner/applicant hereby agree:to hold and save harm• less the City of Everett from any anJ all clairis lor damagea costs, /� ezpenses, or causes ot action that may arise �ecause of inslallation �7(/ � �,�j ��9�� and maintenance of the improvement or other �ight•ohway use hereto % )�G �� app�ied tor and further agrees to remove samo upon notice Irom the Approved for Constru'ction a�e City and to replace public property damaged th�ereby. %�� ;�ir-� �INA INSPECTION Date _ -- Approved es Constructed Signature of Applicant Date everett PUBLIC WORKS DEPARTMENT W�RK AUTHOAIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.TFiIS PERMIT MAY BE Everett, WA 98201 CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS Phone:259•8815 PROJECT OVER 90 DAYS DURATION.