1403 51ST PL SW 2016-01-01 MF Import

�ate.i�',�L� G / Applicetion For PUBLIC WORKS PE�MIT Print or Type Only � PuelicWorkaPermitt v�~/�� eme. oao�.: �1-O � 3 - PUDIic WOAs Fee TolalFee S .,__. Leae AppL Fee PeiG a—��w-^ Balance0uo .i `�'�"— ��-�a��6 qppncant Maiung.4tltlress Cit Y ZiP ?hone Project Address (il known) Attach four (d) copies of plans for propesed work - Draw to scal� and note the tollowing as appiicable: ' • Property Lines 1 • Outline and dimensions of all existing and t proposed structures on the lot ; � • Existing and nroposed utilities PERMIT CONDITIOh 3 • Centerline ot street • Indicale North • Show ar�y proposed grading changes • Show measurements 1. All calls for inspection shall be made 24 hrs. ir. advance • phone 259•881 5. . 2. All work shall Go pertormed in accordance with this permit and current City of Everett Design and Construction Standarils and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. ��.l.rf,� �oa-� `�/5��8� ApprovedforCons uction � !—f /_ �- �J �' �� FI �NSPE ON Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Straef Everett, WA 98201 Phone:259-8815 ACKNOWLEDGEMENT JF CONDITION:i W � � � O � � O a The undersigned owner/applicant hereby agiees to huld a�:d save harm• less the City of Everett from any and all clair^s :or den �ges. costs, expenses, or ca�ses of action th�t may arise because ci 'nstallation and mainten2nce of the improvement or other right-ohw2y use hereto applied tor and further ag�ees to remove same upon no?ice frqm the City and to f'ace public property damaged thereby. / ,� l��' � l�/l�� i��r/d�;f�/� 'Sirnature of Applicant , Date WORK AUTHOfl17.ED BY THIS PERMIT MUST BE STARTED WITi11N 180 DAYS OF DATE PEFMIT IS ISSUED AND TfIEflEAFTER IS TO BE DII_IGENTLY PURSUED TO COMPLETION. THI�S PERMIT MAY BE CANCFLLED BY THE CITY UPON ANY STOPPAGE UF WORK ON THIS PRO.;ECT OVER 90 DAYS DURATION.