1500 52ND ST SE 2018-01-01 MF Import

i � D8t@� �/kI� '� 53 �2 e d9 oe01.b Permu � Application For - PUBLIC WORKS P�RMIT ,' i Print or Type Only `�: 1=,,p r�.�i�'�o�4-CC, �0.� ��3�] �l-e�i'�.r �. Mailing Describe Prpp�sed Work ;,; � �, Publ¢ Woika Fea s � C� Totel Fae �— Less Appl. Fee Pei� f�-l--rw-- ;l � Ba�anceDue S _ �t�ev��", 1J14 �(�203 �Sy Prolect Address (if known) � " " '— - - � Attach four (4) copies of plans for proposed work - Draw to scale and note tne following as applicable: • Property Lines • Outline and dimensions ot all ezisting and proposed structures on the lot • Existing and proposed utilities • Centerline ot street • Indicate Norih • Show any proposed grading changes � Show measurements 3 PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All work shall be periormed in accordance with ihis permit and current City of Everett Design and Construction Standards and Specitications. 3. Call Location Underground Service 46 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. ,/ ��,,,� �p/`v�,.1 � �i �s GLlI�� Z- ��"'Ba � �/� � � qpproved as evere:t �� i`zo +r ,j� PUBLIC WORK3 DEPARTMENT 3200 CedarStreet Everett, WA 98201 Phone: 259�8810 vn�e Date ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett irom any and all claims for damages, costs, expenses, or causes of action that may arise because ot installalion and maintenance of the improvement or other right•of•way use herelo applied tor and further agree to remove same upon notice from ihe Cit nd t re lace p lic pr ry damaged ther by. 2-.'�- � S:gnature ot ApPlicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER iS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WO!iK ON THIS PROJECT OVER 90 DAYS DURATION.