2209 5TH ST 2016-01-01 MF Import

Date 9�1/93 PuELCWo�ksPe�mit� _ eine�oeo��+ 41587 Applicztion For PUBLIC WORKS PERMIT PubTaeiFeeFee $ Less Ap01.Fee PaiG $ — Baiance Due $ Print or Type Only Bill Langus 2209 Sth St Everett 98201 259-3545 Owner Mailing Address �itv Zip Fhone Owner -- Applican� Ntailing Address City Zip Phone Describe Proposed Work Addition � Proiecl Address(if known) 2z09 Sth St � � Attach four(4) copies of plans tor proposed work- Draw to scale and note the tollowing as applicable: � • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures onthelot • Show any proposed grading changes • Existing and proposed utilities • Show measurements M W DO NOT WRITE BELOW THIS LINE � O PERMIT CONDITIONS � 1.All calls for:nspection shall be made 24 hrs.in advance-phone 259•8810. 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction Standards and Specitications. � 3.Call location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. O PUBLIC WORKS PERMI7 � NOT REQUIRED � BY � � i DA7E 9 a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant htreby 3grees to holA and save harm- less the City of Everett from any �nd all claims for damages, costs, ezpenses, or causes of action thn: msy arise because of installation and maintenance ol the improvemen' or other right-obway use hereto applied lor and turther agrees to remove same upon notice trom Ihe Approved for Construction �s�e Ciry and to replace pubtic properry damaged thereby. FINAL INSPECTION Date Date Approved as Constructed Signature of Applicant „�� WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN ��Ii✓ PUBLIC WORi(S DEPARTMENT 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE �J�T Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS Phone:259-8810 PROJECT OVER 9Q DAYS UUAA?fON.