1510 51ST PL SW 2016-01-01 MF Import

Date�„'SiL� Application For PUBLIC WORKS PERMIT Print or Type Only MaiNng Address 7�� Pubhc Works Permil • � � /✓ � BIOp. Dapl. s . �/i s Public Worka Fae Totel Fee a Leas AOD�� Fee Peitl a- Balance Due �i �D� Phone ApplicaM Mailing Address clty up rnone ProJect Address (if known) Attach tour (4) copies oi plans fcr proposed work - Draw to scale and note the following as applicable: • Property L(nes • Centerline of street • Outline and dimensions of all existing and O Indicate North proposed structures ��n the lot • Show any proposed grading changes • Exisling and proposed utilities - • Show measurements ,�s PERMIT CONDITIONS 1. All calls for inapection shall be made 24 hrs in advance • phone 258•881 5. 2. All work shall be pertormed in accordance with this permit 2nd current City of Everett Design and Const��uction Standards and Specifications. 3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 1•800•424•5555. �� f .� �� Approved for Construction�� Date � � �'o�7-f% FI L INSPECTION Date Approved as Constructed everet[ PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 PhonE: 2G9•8815 ACKNOWLEDGEMENT C� CONDITIONS � O � � O a The undersigned �wner/applicanl hereby ayrr.ys to hold and save harm- less the City of Everett from any and all cl�.!ms for damages, costs, expenses, or causes of action that may arise 6ecause of installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notic� Irom the City and to r place public property damaged thereby. ��Q Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STAATED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.