1514 51ST PL SW 2016-01-01 MF Import

Date_3��b Application For PUE�LIC WORKS PERMIT Print or Type Only ling Zip Puel¢ Works Permit s ✓ �/`� eiaa� oeo�. < < v�eim wo�as Fae S Tolal Fea LessA00� Fea PaiE $ �� Balanr.e Oue S � Applicant Mailing Address Gity ZiF Phcne Prolect Address (if known) Attach four (4) copies of pians for proposed work - Drew to scale and nole the following as applicable: • Propnrty Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities �,� PERMIT CONDITIONS • Centerline oF street • Inrlicate Norlh � Show any proposetl grading changes • Show measurements 7. All calis (or inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be performed in accordance with this permit and currer�t City of Everett Dr.sign and Consiruction Standariis and Specifications. 3. Call Location Undergroiind Service 48 hrs. before you dig. TOLL FREE NUIWBER 1•800•424•5555. �� 7� 7�� 8,� Approvetl for Construction � Date � - ,.��3 � FIDI PECTIO ' Date �pproved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 58201 Phone:259-8875 ACKWOWLEDGEMEDI- OF CONDITIONS W H � � O � � O a The undersigned owr:-r/applicant hereby agrees to hold and save harm- less the City of Everet+ .•�m any and all claims for damages, costs, expenses, or causes o1 ;�,,iun that may arise because oF installation and maintenance of tb•• imp' �vement or other right-ohway use hereto applied for and fu�the� ayrees to remove same upon notice irom the City and to placeL�Perty damaged thereby. SI ��nature of Applicant � Date WORK AUTHORIZED BY iHIS PERMIT MUST BE STARTED 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.