9404 1ST DR SE 2016-01-01 MF Import

.. __ ..___..__ '_. . , � � Application For ' � PUBLIC WORKS PERMIT Date �, PUBLIC WORKS DEPARTMENT Public Works Pertnit k 3200 Cedar Street �. Everetl,WA 98201 259-8810 Building Partnit N ITYPE OR PRINT ONLY Public Vlorks Fee$ � ' /� � I Jl( K r.05 1 G�H�er.�..rr� ��SO!• � �u� � \��'d �V['rCly. Ownar Malling Address Gty Z�p Phone I �;��!�S% 'I Applicant Mailing Address City Zip Phone �� l� ,r��J �Pr��P �p � � �A« Pl�. s �� ._ Jc�w+�; C �� i Describe Proposed Work �t v W i -� / c�,/ L . �- , / � q r � ��O�.ble c e a � / �+ J� . �7�G �zi,� 7rdA� �. �E, %I ,t , }o✓ I I � ' J / �♦A I V♦ -�n�l' `�+� ��1,-- .a �Ci,.�j J � G Y ��D Hl.�_ :vi f�- PL��A�A LW^.-.f.�6. ,.�). , ��+-, � _ - � ' 4 i- ' i ! i I ` � �� PROJECT ADCRESS(if known) ( �� l_ �l.— � 5� c' M iii Attech four(4)copies of plans for proposed work-Drew to scale and note the followinp It applicable: O � I •Property Llnes 'Outline and dimenslons of all existing and proposed structures on the lot •Ezisting and proposed utilities . I �Centedine ot slreet •Indicate North •Show any proposed grading changes •Show measurements � DO NOT WRITE BELOW THIS LINE � I PERMIT CONDITIONS: � � 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. O ; i 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and ' �� Construction Standards and Specifications. , I 3. Cali Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. H I i �—' N i � Gt / � i / O 'i 7- �� �, � . �� G �i «�,_ 5�, , �,, , : _ �P�, , , «i� ._ , _, 5 � � � �_ ,�._ �} i � ��w,;� c�(�J�,� s �c��'. �� / l � � I �1 � i I — ACKNOWLEDGEMENT OF CONDITIONS � // /� �4/��7 The ur.dersigned ownedapplicant hereby agrees to hold and save harmless I i I / / the City ot Everett from any and all claims for damagrs,wsls,ezpenses,or I i � causes ot action that may arise because of installation and maintenance of I �' ApprovedforC nstructio ' �a�e theimprovementorothernght-oi-wayuseheretoappliedforantlfutlherag�ees � to remove same upon notice from the City and to replace public property � damaged thereby. �.��" i � FINAL INSPECT1011 Date ' . �'� �. � '�. I Approved as Constructed ,-�� ! .' �/ :.. �' , i Sipneturh of Applican ! ..� Date ' I I WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED A ERF1'.FfER IS TO BE DILIGENTLY PURSUED TO , I COMPLEf10N.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. �.