3014 56TH ST SW 2016-01-01 MF Import

Date�� Application For PUBLIC WORKS PERMIT Print or Type Only owner ApFlicant l �l t A jdrr,ss Address Pu�lic Works Permll M ��" ��S Bb1p. CIePI. f,_,��n`3�__ PuOilclbr�;;ea s � To:+ �°na _ Lea. AnGt Fee PaiE S __ Belenn3pue S 2��0 _� Zip ��Y Zip Descr'be Proposed Work /l�f� ltl L6.VJ7.2UG%/iy�� /`JdD SC/' S/,v��Lc �� — � ! r�h" - 3c�/� Project Address (if known) � Attach four (4) copies of plans for proposed wnrk - Draw to scale and note the following as applicable: � Property Lines • Outline and dimensions of all existing and proposed shuctures on the lot • Existing and proposed utilities PERMIT CCh:01TIONS • Centerline of street • Indicate North • Sh�w any proposed grading changes • Show measurements 1. All ca�ls ior inspection shall be made 24 hrs. in advance - phone i59-881 5. 2. All work shall be pertormed m accordance with this permit and r.urrent City cf Everett Design and Construction Stantlarcls and Specificationa 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM3ER 1•800-424-5555. �..�c�ioa-�� 5� /6�86 Approved for Construchon �Date �� 7—b2 -� FINAL I CTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 ACKNOWLEDGEMENT OF CONDITIONS W � � � The undersigned owner/applicant hereby agrees to hold and .^,ave harm• less ihe City oF Everett from any and all claims (or damagts, costs, expenses, or causes ot action that may arise because of instsilaticn and maintenance of the improvement or other right-of�way use h��reto applied for and further agrees to remove same upen notice fror,i the City and to replace public p�o erty damaged ihereby. 1I �� '-B� Sig ture ofnh Applicant' Date WORK AUTHORIZED BY'Hlu P[RMIT MUST BE STARTED WITHIN 180 DAYu OF DATE PERMIT IS ISSUED AND THEREAFTER iS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIf NAY BE CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.