12402 19TH AVE SE 2016-01-01 MF Import

� AP�I�cation For + — PUBLIC �WORKS PERMIT D'aie_ PUBLIC WORKS DEPARTMENT Public Works Pertnit p 3200 Cedar Street C Everett,WA 98201 259-8810 Building Permit 8 � ✓� TYPE OR�RINT ONLY Public Works Fee$__ �ri�� ; - Owner � MailingAddress City Zip Phone Applicant Mailing Address C�p� Zip Phone � Describe Proposed Work ' � G� � MPN � � PROJECT ADDRESS(if known) �a ( �Z — � ✓� � Atlach four(4)cupies of plans for proposed vrork-Draw to scale and n��g if applicable; �r � •Property Lines 'Outline and dimensi�ns o1 all existing and proposed simctures on ihe lot •Existing and proposed utilities O •Centerline of street 9�dicate North •Show any proposed grading changes •Show measurements � DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS: � 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O 2. All work shall be pertormed 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. � V♦ 1�� Se Q�A �E PlM . t �- a � � J �� n�� -Vas l'2�u�Y Paf, I ACKNOWLEDGEMENT OF CONDITIONS The undersigned ownedapplicant hereby ayrees to hold and save harmless the City of Eveietl from any and all claims for damages,costs,expenses,or Approved for Construction Date causes of action that may arise because ot installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from ihe City and to replace public property damaged thereby. FINAL IWSPECTION Date Appwved as Constructed Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STAfiTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E CANCELLED BY THE C�TY UPON AN'i STOPPAGE OF WORK ON 7HIS PROJECT OVER 90 DAYS OURATION.