1410 51ST PL SW 2016-01-01 MF Import

Date�� / Appfication For PUBLIC WORKS PERMIT Print or Type Only nnamng Adaress a�y Gity Descri6e Proposed Work �iJIW� I �_l� � �pJ'•� �P�tLl Project Address (if known) Public Wodf Permit ♦ BIEp. DepL • �� 7� 7/ PUEIic Wo�ke Fee Total Fee $ Less AOPI. i e5 Peitl S Balanca Oue S Attach four (4) copies of p:ans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North �" .i, proposed strudures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements rnone rnone PERMITCONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. 2. All work shall be pertormed in accordance with this permit and current City of Everelt Design and Construction Standards and Specifications. 3. Call Locatiori Unde�ground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-4245555. Approved for Construction T,\�/. i�wM : �, v�ok. re��1�-c.d. (a-2i-91 ACKNOWLEDGEMENT OF CONDITIONS W H � � � � a The undersigned owner/applicant hereby agrees to hold and save harm- less the C!ty of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other righPohway use hereto applied tor and further agrees lo remove same upon notice from the Date City and to replace public property damaged thereby. FINAL INSPECTION Date Approved as Constructed �A`I�PUBLIC WORKS DEPARTMENT 3200 Cedar Sireet Everet�, WA 98201 Phone: 259•8810 Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUSf BE STAFTED 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 Pl70JECT OVER 90 DAYS DURATION.