1002 51ST PL SW 2016-01-01 MF Import

�r Date�/1C,C�p Application For PUBLIC WORKS PERMIT Print or Type Only � Pu�lic Works Permil • _ BIdp.Oept.+ 9fJ�irj,�QQ Puelic Worka Fee Totai Fee $ LessA001. Fee Paid $ 8alanca Due $ Insox Rhine & Bette Fatzlaff 1002 - Slet P1 SW Lvazcitt 98203 348-4732 Owner Mailing Address City Zip Phone Mailing Address Describe Proposed Work Bedroom addition Prolect Address (if known) City 2ip Phone Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines � Centerline ot street • Outline and dimensions of all existing and • Indicate North '• proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDI710NS 1. All calls tor inspection shall be made 24 hrs. in advance • phone 2J9•8810. 2. All work shall be perfo�med in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. �all Locai'on Underground Ser.�ice 48 h�s. before you dig. TOLL FREE NUMBER 1•800•424-5555. �ln ��uu� ��o�� iT ✓e�� L�� Approved for Construction FINAL INSPECTION Approved as Consiructed everett PUBLIC WORKS DEPAR7MENT � 3200 Cedar Sireet Everett, WA 98201 Phone:259•8810 t-�..��s-.-� �1'� `K��-h- Date Date ;= -._ �_ 10 W H � � 0 � � � a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City ol Everetl Irom any and all claims for dzmages, costs. expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of•way use hereto applied tor and furlher agrees to remove same upon notice from the City and to replace public property damaged thereby. Signa�ure of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAv BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJEGT OVER 90 DAYS DURATION.