8921 10TH DR SE 2016-01-01 MF Import

� f " ' = s Date �� :��v��k��•��„�a _7 <<, — ._�{ � ApFlication For Bldq Depl.+r��//G�r�i/G7 - � T. PUBL�C WO�RKS PERMIT Pu�IlcWatksFrc Total Fea 5— _ Ias.,+pplfcePalJs_— __ C�rnnec Due $ �� Pri t or Type Only �--' .'li-'y/.,�r7� .i.orif'/s�. '.L' 'ii-7 Lvs',�'.l %�'i:;� _ C�. ..� ;, �iai `,' ' =, 'o _ �e>^. _ C '.? i Owner Mailing Address City Zi, Phone ��t_ � �� C � � �� Ii' t! ..'/ �� S� G �L C p.e � / / � �' c :%A'�i. G i , o•' c� i �;r�� Ld,a 4 i �� (�' G��n , App�icant Mailinq Address City Zip � Phone � Uescribe Proposed Work i C ' �� .��c'�� f�..�i .f� `�-�Z�„r��f i?� ,� �� _ � — � L i(/ � � � Project Address(if known) �� .�+ .� n _ • ,�� ' �i�-C-r[�/ C�L/i,..• . _ Altach lour(J) copies of plans lor proposed work- Draw to sc le and ote the tolto�vin� as applicable: GnT � �-O -a M/A/!/iEo J �S w _ O Property Lines • Centeuine of slreel v� • Oulline and dimensions of all existing and • Indicate NortY� proposed structures on the lot • Show any proposed grading changes • Existing and proposed utililies • Show measurements � DO NOT WRITE BELOW THIS LINE � PERMIT CONDITIUI:;. 1. All calls(or inspecuon shsll 6e made 24 hrs. in advance- phone 259•S8�5. � 2. All work shall be perfonned in accordaece with ihis permit and currenl �ity of Everett Design and Construction Standards and Sper,ificalion^,. 3. �all Localion Underground Service 4E hrs. belorP you dig. TOLI FREE NUMBER 1•BOO•424•5555. � � �w �/ � l�o� hCKNOWLEDGEI.IENT OF CONDITIONS ll��e und�r;iqned owner/apClican(hereby a9recs to hold and save harr.- Icss �he City of EvereU from any and all claims for damages, costs. / cxp^nses, or causes ol action that may arise because of installation �—� '� � f �--/� v� and main�enanca of the improvement or other right-of�v+ay usc herclo 1f � 1 � �f�j�= O zpplied for and turiher agrees �o remove same upon notir.e trom thc �oved fo�Consiruction . Date City and to replace public property damaged thereby. RD,AL IIJSPE `T O ^ Date ',lr' ��-..,-� S�' � ��l-� Approved as Coi structed Signa�ure of Ap licai{f � Dnte everelt PUBLIC WORKS DEPARTPAENT WORK AUTHONIZED BY THIS PERMIT MUST BE STARTED WITHIN � 3200 Cedar Sireel 180 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO Everetl, N!A 982J1 BE DILIGENTLY PURSUED TO COMPLETION. THI` ��ERMIT MAV BE Phone: 259�8815 CANCGILED BY THE CITY UPOfi ANY STOPPAGE c;f WORK ON THIS PROJFCT OVER 9G i?AYS DURATIOtJ.