1406 51ST PL SW 2016-01-01 MF Import

� Y .Jate��d Applicafion For PUt3LIC WAaKS PERMIT Print or Type Only � _ Applicant Mailing Address Describe Proposed Work — .5% -sri Project Address (if known) c��Y Publ¢ Works Permrt t �� `� G Bieg. Dept. e PUEbc WorFSFee s Total Fee Le;s /OVI Fee PeiO f +J Balancoflue S 4��- Zip Z�P Phone Attach four (4) copies of plans for p�oposed work • Draw to scale and r:ute the lollowing es applicable: • Property Lines • Outline and dimensions of all existing and proposed shuctures on the lot • Existing and proposed utilities PERMIT CONDITIONS • CeMerline of sireet • Indicate North • Shuw any proposer! �rading changes � Show measuc?ments 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall 6e performed in accordance with this permit and current City of Everett Dcsign &nd Con;truction Standards and Specificationa 3. Call f.ocation UndergrounA Service 46 hrs. bef-?ro you dig. TOLL FREE NUMBER 1•800-424•5555. � ��, �. y' � :�� A�proved for C struction � Da� � i �ll� ' /- �'7- �� FIN9lrf SPECTION Dale Approved as Constructed everett PUBLIC WORKS DEPPRTMENT � 3200 Cedar Street Everett WA 98201 Phone:259-8815 ACKNOWLE�GEMENT OF CONDITIONS W � � � � O � � � a The undersigned owner/applicant hereby agrees to hold and save harm• less the Citv of Everetl from any and all claims for damages, costs, eepenses, or causes of action that may arise because of installation and maintenance of the improvement or o;her righPof-way use hereto applied for and lurther agrees to remov? same upon uotice from ihe City and to replac public property damaged thereby. �//!C!%�z�� /� Signatu��: ^t Applicant Date WORK A:1?rIORIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 O�,Yu ��F DATE PERMIT IS ISSUED AND THEREAFiER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCE�LED BY THE CITY UPON F NY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.