1415 122ND ST SE 2018-01-02 MF Import

spy01 2zl Y i t 1 G ®ate Q� Public Works Permit # t, Bldg. Dept. Application For VUO' R KS R E R M I T PUbTota Fee Fee $ P' 13 Less Appl. Fee Paid $ l Balance Due $ �V Print or Type Only 91 w, AU "Cl z 364 —)��a Owner Mailing Address City Zip Phone 12 ru Applicant Mailing Address City Zip Phone � �� / Y � Describe Proposed Work S �ytf1r e 4441JXrpi owip� Y,Ji/p,-Z,[14 (2- Z� r'✓IA ;y: W Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street. • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show:any proposedgrading changes • Existing and proposed utilities • Show measurements 00 NOT WRITE BELOW THIS LINE PERMIT` CONDITIONS O 1. All calls for inspection shall be made 24; hr . in advance hone 259-8815., 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction S p Standards and -Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TDLL FREE NUMBER 1-800-424-5555. ' 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 instaflation ' and. maintenance of the improvement or --other right-of-way use hereto 11'�719 -� p applied for and further agrees to remove same upon notice from the Approved for idn ate City and to replace public property damaged thereby. FINAL INSPECTlO Date_%�% Approved as Constructed Signature of Applicant ate everetf PUBLIC.WORKS DEPARTM_ ENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN.' 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Everett, WA 98201 s BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Phone: 259 8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.