427 50TH ST SW 2016-01-01 MF Import

Date ��1 Applicntion For PUBLIC WORKS PERMIT Print or Type Only Mailing Describe Proposed Work _ `Lly�� I �� Projec! Address (if known) _ �.o�� Gny Public Works PB�mIt Y �'�� eia9. oeot. • r�mi� wo�xs Fee s Totel Fae Leae AOG� Fae Peld s � Balance Due S �D Attach four (4) copies ot plans for prcposed work - Draw to scale and note the following as applicable: • Property Lines ,• Centerline of street • Outline and dimensions of ali existing and • Indicate North propoaed structures on the lot • Show any proposed greding chnnges • ExlsNng and proposed utilitias • Show measurements rr.one PERMIT CONDITIONS 1. All calls for inspeci!on shatl he made 24 hrs in edvance • phone 259-8815. 2. All Nork shall be periarmed in accordance with this permit and current City of Everett Design and Construction Stsndards and Soecitications 3 Gal� Location Underground Service 48 hr& before you dig. TOLL FREE N.UMBER 1•800�424•5555. Approved for Con %%tr ��''� ipn Date ,�'s��i�f��' /�-J-L7 FINAL INSPE�CTI N Date Approved as Consrructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259-88'5 ACKNO\NLEDGEMENT OF CONDITION� � O � � O a The undersigned ownerlapplicant hareby agrnes to hold and save harm• Iess ihe City of Everett irom any and all cl•rims for damages, costs, expensas, or causes of activr� :hat may erise because of installatlon and maiMenanca of ihe improvxr.�wnt or other righ4ot-way use hareto applied br and furt er agress t� rc•move same upon notice trom the City and to rep c public prop:-rt %maged thereby. A�� �� -2c�-8 Signature of Applicant Da� WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND �FIEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGF OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.