1529 51ST PL SW 2016-01-01 MF Import

�ate'� Application Fo� PUBLIG WORKS PERMIT Print or Type Only Mailing 0 Pubhc Wo�ks Parmil s � BIE9. Dept M Publlc Warks Fee s Total Fae Less AppL Fae Paid $ c,ia��a o�a s 20 ��- 2ip Fhone Applicant Mailing Address City �ip Phone Prolect Address (if known) Attach four (4) copies o( plans for proposed work - Dra�v tu scale and note the following as apPlicatile: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities � 7 n��;,u Approved PERMIT CONDITIONS • Centerline of street • Indicate North • Show any p�oposed grading changes • Show r�easuremen;s 7. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be performed in accordance with this permit and current Ci�y of Everett Design and Construction Stsndards and Specification;.. 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMHeR 1•800-424•5555. �� i . �✓ "�— as Constructed i — � � -� _ (f'�� Date j everett PUB! IC WCi�KS DEPAFTMEN7 �, � 3200CedarStreet Everett, WA 98201 Fhone: 259-8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigned ow�er/applicant hereby agrees to hold and save harm- less ihe Ciry of Everett from any and all claims for damages, costs. expenses, or causes of �ction that may arise because of installation and mainlenance of the improvement or other right-of�way use hereto applied lor and further agrees to remove same upon notice from the City and replace public property damayed therety. 4 • �� Sianrture of Appiicant Date V60RK AUTHORIZED BY THIS PERM�T MUST F3E STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELIED BY THE CITY UPON AN`� STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.