608 58TH PL SE 2016-01-01 MF Import

Oate�_� Puphc Wart,Perm11A (96(�—�,-GJ/@J Application For Bldg Deal a _T _ PUBLIC WORKS PERMIT Pubes Warks Fee Tolal Fee 6 Let$app[Fee Paid S�_ Print or TypeOnlyaalanceDue Owner Mailing Address City Zip Phone Applicant Mailing Address City Zip Phone Describe Proposed Work Project Address(if known) jl-2 .�rx;' _L? d'ag -S8Y'AG Attach four 141 copies of plana for proposed work• Draw to scale and note the following as applicable: s� • Property Linea • Cenlerllne 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 DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 bra in advance•phone 259.8815. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cali Location Underground Service 48 bra before you dig TOLL FREE NUMBER 1•800.424.5555. S O 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, costa o/ expenses, or causes of action that may arise because of Installation and maintenance of the Improvement or other right-of-way use hereto Approved for Construction Dale applied for and further agrees to remove same upon notice from the City and to replace public property djVnaged thereby. INAL INSPECTION Date Approved as Constructed Sig ature of Applicant ate Pverett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE START late 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE Phone:2EB•BBt 5 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.