3005 19TH ST 2018-01-02 MF Import

Date t ^UV Public Works Parmll Application For Bldg Dept, PUBLIC WORKS PERMIT Public Works Fa Total Fee e g Less APPL Fee Paid 5 Print or Type Only Belem. Due S Mailing Address City Zip Mailing Address City Zip Phone Describe Proposed Work (Ictef ey af r V Project Address (if known) l_. 1yD _S_b_ W Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street 'A • Outline and dimensions of all existing and • Indicate North v+ proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements Y DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 his. in advance - phone 259.8610. 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 his. before you dig. TOLL FREE NUMBER 1-800.424.5555. z no+- (Eqjiren O /� ra 8C9 FM Cl) O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less 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 Approved for Construction Date City and to replace public property damaged thereby. FINAL INSPECTION Date Approved as Constructed Signature of Applicant Date everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Everett. Cedar 9 tree BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Phone:2 A98B .-O CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS le PROJECT OVER 90 DAYS DURATION.