6301 1ST DR SE 2016-01-01 MF Import

/ Date��+JJJ � ...Nl�D � �u0iic Wmha Pm�, � ema.oen�...� �<�i� i p. Application Fbr � PU�IC WORKS PERMIT Po�imWak�Fee Total Fce S- OLess Aop��Fee Pa�tl S � p p p (V O p p O O O CJ Balance Oue S � � Print or Type Only� v� o 0 o u� o 0 0 0 0 0 � •��'�Xo oo � M w � « � ° m » � 1�� N � � o - Ow er � � � =i � �� Q i w City ZiP Phone . - . . 5`�j {;`, $ a d5 S� � S�n�� .-�. iTS ..r� Y. Applicant Idailmg Address City LP Phone �C+x� ��, Des�:ribe Proposed Work –�� 1� ` J�� V� �i�-7 ��—�Y �� L./ ' W Proiect Address lif known� Cs 30'1 — S 5�- �2 SL � Aflach fow(4)copies of plans lor proposed work- Draw to scale and no�e the lollowing as applicable: � • Property Lines • Cenlerline ot street � • Outline and dimensions of all existing and • Indicate North proposed struc�ures on ihe lo� • Show any proposed 9rading changes • Existing and proposed utilities • Show measuremenls /M W DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � 2.All work shell be performed in accordance wilh this permit and current City of EvereU Design and Construction Standards and Specitications. 3.Call Location Unc,erground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � 4.ANY CHANGE IN THE DRIVRWAY CUT MUST SF APPROVED �/' BY THE PUSLIC WORKS INSPECTCd_ � 5.CONNECT DOWNSPOUTS TO PUSLIC DRAINAGE SYSTEM. 6.KESP CITY SIREETS CLfiAN AT ALL TIMES. � 7_ANY DAMAG$ TO THE CURB AND SIDEWALK WILL BE REPAiRED TO THE SATISFACTION OF 'PHE PUBLIC WORKS DEPT_ O I �'-I ACKNOWLEDGEMENT OF CONDITIONS 11�� The undersignetl owner/applicant he�eby agrees to hold and save I ��- less the City ol Everetl Irom any and all claims for damages. costs. ezpenses, m r,auses c' action that may arise because ol inslallation � �,� r, K¢� �_�3 �� and maintenance of �he improvement or other righl-obway use herew , applied lor and furiher ac�rees lo remove same upon notice Iro�a the I Approved tor Cons u {Yon / Date City and to replace public properry damaged thereby, / ,�7 ' ��s- l''��/� d -„� T-�i , ,�/�,�� ,� FINAL INSPECTION Date ' �'� � Approved as Censtructed Signature ol Applicant Date WORK AUTIIURIZED BY THIS PERMIT MUST BE STARTED WITHIN everett PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � 3200 Cedar Sireet BE DILIGENTLV PURSUED 70 COM1IPLETION.THIS PERMIT MAY 8[ Everelt WA 98201 CANCFLLED BV THE C:TY UPON ANY STOPPAGE OF WORK ON THIS Phonc:259�0810 PROJECT OVER 90 DAYS DURATION.