10903 3RD DR SE 2016-01-01 MF Import

� Date�_��L-.�Y P„��,<<v��k��o�m��. �--n�/�� ApPlia:itian For eme.o�a�.• � �—s� PUBLiC WORKS PERMIT P°°;o,`,F��`�° s Lws Aoo�.Fea Paia 5 OpI011C0�U� S "� Print or Type Uniy C�anna. rr� ?i� �- 1�jI�F - iV .3� 1 ,�� r��0 7 .SP� If� � �l�"IUZi S�/7-�a3 Owner Mailing Address Cily Zip Phone S�1 N1 Q — Applicant Mailing Address City Zip Phone Describe Proposed Work � A S nf(� �v11 ��/ j1�rl� (J l fi7� �� 7!t)�N l P/��Ij/� . i W Project Address(il knownl �0 90.3 — '��vic' S�-_ � Attach lour(4) copies of plars lor proposed work• Draw lo swle and note�he Iollowing as applicable: � • Property Lines • Centerline ol siree� ♦A • Outline antl dimensions of all exisfng and • Indicate Norih M� proposed structures on the lol • Show any proposed grading changes • Existing and proposed utilities • Show measurements ,w/� W DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS i. All calls for inspection shall be made 24 hrs. in aovance-phone 259•881 5. i� 2. All work shad be performed in accordance wilh U�is permit and wrrent City of Everett Design and Construclion ♦ Standards and Specifications. 3. Call Location Underground Serv�ce 48 hrs.before you di�.TOLL FREE NUMBER 1-500•424-5555. � 4. Curb, gutter, a d sidewalk are new 6 unbroken, any damaye to them shall � be repaired/repiaced by the applicant. 5. Fmy driveway location changes must be approved by the Public Works Dept. � and insgected prior to construction. 6. U�e public drainage system provided for roof-top �ok��spouts. � O a ACKNOIVI.EDGEMENT OF CONDITIONS The undersi�ned owner/�ppli:ant hereby a9rees to huld and save harm� - � Iess the City of Everett Irom any and al! claims lor damayes, cosls, _,-� , �� expenses, or causes of action Ihal may arise because ol installation , ; �� i .�4��__..,/y.,�� (J/,?'� and mainlenance, of the improvemenl or other ric�ht-obway use hereto ��'�'' �� applied tor and further agrees to remove sem� upon no�ice from the Approved lor Constructi6n 6a�e �ry and to repl��• public property damaged ihereby. /� j • . /� � �� / ,��!,! -� , �. � ,r,., �f �� %� �.. ;�G�,, ;�� - I ,,� ,/l�L�.n�; � � . � . ;. FINAL INSPECTION " � � Date � � —�` App oved as Conslructed Signature of ApplicaM � Dale everetl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST I3E STAR ED WITHIN � 3200CedarStrnet 180 DAYS OF DATE PERMIT IS ISSUED AND THC-REAFTER B TO BieretL WA 98207 �E DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Phone: 259�&815 CANCELLED BY THE CITY Uf'ON ANY STOPPAGE OF INORK ON TIi15 PROJECT OVER 90 D�YS DURATION.