917 51ST PL SW 2016-01-01 MF Import

� Date��. �:� , •�, Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address Public Works Permit s �/ ~� � �f � �� 8149. Dept. a . / • � Pu�licWorksFee g TotalFaa less Appt Fee Paitl � Balance Due $ �^,, � � � �;-r�;l� � �� City Zip P � Applicant Maiiing Address City Zip Phone Describe Proposed Work l �. Project Address (if known) Attach four (4) copies of plans tor proposed work • Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existin9 and • Indicate North proposed structures on the lot • Show any proposed grading changes • Exisling and proposed utilities � Show measurements PERMIT CONDITIONS 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 City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424-5555. �7 UB�: iL �vo.P.t/' PG,einiT it/Or .PEc,�u�2E-o ApprovedforConsVuction Date FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENI" � 3200 Cedar Street Everett, WA 98201 Phone: 259•8875 Date ��, 8 isj-�s� ACKNOWLEDGEMENT OF CONDITIONS �- W H � � O � � � a The undersigned owner/applicant hereby agrees to hold and save harm- less the Cily of Everett from any and all claims for damages, costs, expenses. or causes of action that may arise because of instal�ation and maintenance ot ihe improvement or other right-of-way use nereto applied for and further agrees to remove same upon notice from ihe Ciry and to replace public property damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE OILIGENTLY PUflSUED TO COMPLETION. THIS PERMIT MF,Y BE CANCELLED BY TF�E CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.