1512 51ST PL SW 2016-01-01 MF Import

� Date__�� App�icatiun For FiJBLIC WORKS PERMIT Print or 7y�e Only ling Describe P�oposed Nbrk Project Address (if knownl City c�[y Attach f�ur (4) copies of plans for proposed wcrk • Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all exi�tir,g aiid proposed structures on the lot • Existing and proposed utili!ies �' PERMIT COIVDITIONS Pu01¢ Works Per t s `--' � /� � BIEp. OeO�. y ��1� PuEhc Works Fee Totai Fee s Less AOV�. Fea Paitl .S Balance Due S 2Gj OU • Centerline oF street • Indicate Norih • Show any proposed grading changes • Show measurements Phone 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All worrt shall be performed in accordance with this permit and current City of Everetl Design and Construction Stand2ros and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEF 1-$00•424•5555. �).�s��o��.— %��8� App�oved lor C�onstruction � � L`ate / /�� i ` o-� 7_ �=j FINAL INSPECTION Date Approved as Consiructed ��everett PUBLIC WOFKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 / Phone' 259•8815 ACKNOWLEDGEMENT OF CONL'ITIONS W F- � � � O a Thr undersigned ewner/applicant hereby agrees b� hold ar.� �ave ha�m- les; the Cdy of [verett irom any and all claims for dama,.�•,, costs, exUenses, or causes of action that may arise because of ins�allation and maintcnance of Ihe improvement or other right-of-way use I.ereto applied ior and lurther agrees to remove same upon notice trom ihe City and o replace public prop rt damaged theieby. r�..=:� % T ignature of Applicant Da e WORK AUTHOHIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILi3ENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCE�IED BY TH[ CITY UPON ANY STOPPAGE OF WO�K ON THIS PROJ�CT OVFR 90 DAYS DURATION.