1404 51ST PL SW 2016-01-01 MF Import

Date��3a/ Applicatio� For PUBLIC WORKS PERMIT Print or Type Only PubllcWarksPennll+ v �—/�/ ,. Bltlp. Dep1. y — - Pu�llc Works Pee S, Total Fee Lesa POPI. Fae Pa�E $ � Balance0�e S `?�O— 'AppilEant Mailing Addr..ss Gity Zip Phone 5�� S� ._ S;'. ST_ Project Address (if known) 66�q{I[��« ��'i� Attach four (4) copies u1 plans for proposed work - Draw to scale and note the tollowing as applicablc • Property Lines • Outline and dimensions of all existing and proposed siructurefi on the lot • Existing and proposed utilities � �� • Centerline ot street • Indicate Nath • Show any Nroposed grading changes • Show measurements PERMIT CONDITlONS � 1. All calls for inspection shali be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be pertormed in ar.cordance with this permit and current City of Everett Design and Construction Stander[ls and Specifications. 3. Call Location Underground Service 49 hrs. betore ycu dig. TOLL FREE NUMBER 1•800•424-5555. �C�!•' �-�- aa�� ,c> >96 Approved t�r Construction �� Date // �(( �(� , /' ��' � �__ FIN SPECTION Date Approved as ConsVucted evere[t PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett WA 98201 Phone:25°-8815 ACKNOW�EDGEMENT OF CON�ITIONS W � � � � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less ihe City of Everett Irom any and all claims for damages, costs, expenses, or causes ot action that may arise br.cause of ins�allation and maintenance of the improvement or other right-of�way use hereto applied lor and further agrees to remove �ame upon notice irom the City anA to eplace public property damageri !hereby. � �O °d �nature Ap0licant 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 FERMIT MAV BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PFOJECT OVFR 90 DAYS DURATION.