12001 14TH DR SE 2016-01-01 MF Import

Date.�:L`ZO l a�oi�wo,�.s a<<R�i n _ BIdB.DePt.s �� I �r�I � Applicalion For PUBLIC WORICS PERMIT PbTolafoaFco S Less Appl.Fee Paitl S Balance Duc $ . Print or Type Only — (� � �'Pi� �� ►�� r- ��c ��-r��7 ��ao� a��-�4�� pW Mailing Address City Zip Phone C�LA��Y� -- Applicant Mailing Address Gry Zip Phone Describe Proposed Work 1��5_ � i W Pwject Address(it known) � � �� H � Adach(our(4)copies of plans for proposed work- Draw to scale and note the tolluw.ing as applicable: � � • Properry Lines . • Centerline of sireel ♦^ • Outline and dimensions of all existing and • Indicate North V� proposed siructures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measuremenls /� W DO NOT WRITE BELOW THIS LINE o PERMIT CONDITIONS 1. All calls for inspection shcll be made 24 hrs. in advance- phone 259•881 5. � 2. All work shall be performed in accordance with ihis permit and current City of Evereit Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800-424-5555. � 0 (�� H / � �� '� -�� ; � � `� � 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 ihat may arise because of installalion and maintenance o� ihe improvemen� or other rigM-ot-way use nereto applied for and furiher agrees to remove same upon notice irom the qpproved for Conslruclion �a�e City and to replace public property damaged there6y. PINAL INSPECTION Date Approved as Constructad Signature ot Applicant Date everett PUBLIC WORKS OEPARTMENT WORK AUTHORIZED 6Y THIS PERMIT MUST BE STARTED WI7HIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone: 259-8875 ppOJECT OVER 90 DAYS DURATION.