5116 33RD AVE W 2018-01-02 MF Import

TYPE OR PRINT ONLY 611414 N Owner 1117M Application For PUBLIC WORKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 259-8810 Date 3 - 3 / - Q 8 �7.7-' Public Works Permit R 0 Building Permit 8 _ tW Public Works Fee $20 Ob ,e //87 f/� t72Fg 92627S��s�iz� ;s City Zip Phone 'Applicant Mailing Address City Zip Phone Describe Proposed Work �-,ENCE L-O? O.0 6&-L—�S7- S7,Pe Uj ca-03-96 1I�46Ahi � R 98076 ♦/\ OTHER 20.00 V/ PROJECT ADDRESS (if known) .j / fe-. , W • '! 0T4I_ 20.00 Attach four /4) copies of plans for proposed work - Draw to scale and note the following if applicable: CASH H4.NOE "Property Lines "Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utipties-., ©y or "Centerline of street •Indicate North •Show any proposed grading changes •Show measurements PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. O 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. TALL FREE NUMBER 1-800-424-5555. 4 IF 7; CIT nl�ros To vsc TWIT fC.6,,91r of c�Ay T,�c.c/ 7>>��' extv�/c� AT AIIJ c�sT a i Approved as Constructed ^3 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Signature of Applicant ate WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.