803 52ND PL SW 2016-01-01 MF Import

Date �/� � I Public WorMn Permil ��j6 7 BIEp. DePt � �� Applicetion For - PUBLIC WORKS PERMIT Print or Type Only Dcscribe Proposed Work Pro�act Address (if known) � %�� % �- Mailing Address So3 51'rO �.,� � Mailing Address Q�� ,� Puelic WOIXs Fee s �Q� Tolel FPa Lees Apo�. Fee Paid S�sr�— .Jo �,.._ Belance Due ��_ L `'��/% Zip / Zip Attach tour (4) copies of plens for proposed work - Draw to scale and note � Ceniterline ot stPeei; able: • Property Lines • Indicate North • Outline end dimensions of all existing and � Show any proposed grading changes pro0ased structures on ihe lot � Show measurements • Existing and proposed utilities �pcs pG rnone PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs in advance -�.�one 259•881 5. 2. All work ahell be performed in accordance with this permil and current City of E•+eretl Gesign and Construction Standards end Specifications 3. Call Locetion Underground Ser�ice 48 hrs. before you dig. TOLL FREE NUMBER 1-900•424•5555. � rD��/� tS'�V. ��/� � Date Approv3d as Constructad everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Slreet Everett, WA 98201 Phone: 259-8815 � O � � � a ACKNOWL[DGEMENT OF CONDITIONS The unde�signed owner/applicant hereby agrees to hold anA save harm- less the City of Everetl irom anY and all claims for damages, costs, expenses, or causes of action thal may arise because of installation and maintenance ot tha improvement or other right-of•way use hereto appli�d lor and further agrees lo remove same upon notice Irom the City and to replace public property damaged thereby. .�= - ignatureol pplicant' Date ORK A HORI2ED 6Y THI" PER MUST BE STARTED WITIiIN BE DIDLIGENOTLY�PURS:IED�TO COMPLE�TION.DTH SEPERMIT MAY BE CANCELLED Bl' THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 50 DAYS DUAATION.