1409 51ST PL SW 2016-01-01 MF Import

oe��ti3�1P6 ApplicaHon Fi�r PUBLlC WORK;� PERMIT Print or Type Only Describe Proposed Work Publit Worka Permli R "'� � /�� eiav. oea�. s �T� PuElic Wo�kn Fee Tolal Fea s Leas Appl Fae PaiC S 89lenca Uue s �O� Mailing Address Ciry Lip rnone Prolect Address (if known) Attach four (4) copies ol plans tor proposed wurk • Draw to scale and note the following as applicable: • Property Lines • Centerline of st�eet • Oulline and dimensions of all exissting and • Indicate North proposed structures on the lot • Show any proposed graaing changes • Existing and proposed utilities � Show measurements PEF^11T CONDITIONS 1. Ail cal�s for inspection shall be made 24 hrs in advance - phone 259•88S 5. 2. All work shall be pertormed in accordance with this permit ard current City of Everett Design and Construction Standerds and Specifications. � 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NL�MBER 1-800•424-5555. �� '� � � a6 Approved'orConsiru ion Date � � � /-^ ' 6% FIN ECTION Date qpproved as Constructed everett PUBLIC WORKS DEPARTM'NT � 3200 Cedar Sireet Everett. WA 98201 Phone: 259•8815 ACKNOWL'_DG[MENT OF CONDITIONS The undersigned owner/applicant he�eby agrees to hold and save harm- less the City of Everett from anY and all claims for damages, cosis, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-ohway use he�>!; applied lor and further agrezs to remove same upon notice from ��c City and.i'o replace public property damaged thereby. �J / i Signature o( Applicant Dare WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THEflEAFTER IS TO BE DILIGENTLY PURSU'c0 TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CI�iY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DA''S DURATION.