623 58TH PL SE 2016-01-01 MF Import

Date'' / ^vbec Worb Per • (�G�.B Aplvicahon For Bldg Dept a�� PUBLIC WORKS PERMIT Pub,q wg xe Fe. Totet Fee Len APPt Fee Paid III Print or Type Only Behnce Due III L tGwner Meiling Address City Zip Phone 1 APP scant Mailing Address /J City Zip Phone — - Describe Proposed Wort Cdl �G�� JB !✓i�G, `LU Project Address dl known) Attach lour 14)copies of plans for proposed work- Draw to scale and note the following as applicable: IN • Property Lines • Centerfine of street 1 • Outline and dimensions of all existing and • Indicate North :.i proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements J DO NOT WRITE BELOW THIS LINE O iPERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs.In advance•phone 259.881 5. 7 2. All work shell be Performed In accordance with this permit and current City of Everett Design and Construction ' Stan-lards and Specifications. I 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-1300-424-5555. z I 01-11 W,11y LOCATi,'"/ ON It eqV Deer I L/.vE-a lTiiT// E'x�sT.w(r ,diPivC.✓.9f/, I y Ek�sr..✓b D.ei��Es:Ay /vlr,:tr dE 7'A.rE�✓ ovr h'�vo X'E�'pi,GEv ltJiTf/ FvL L yE76.yr Cv�d PE�c' �l/lJi9�P.o ♦^ �ql ,foS 306 , M♦ C/y STA�vDA,efj x`307 6- A)64) Al 70 Af ZWSMteeO 0 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 damaoes. costa, expenses, or causes of action that may arise because of installation `— -l'�' jBa � /�•�•BG and maintenance of the improvement or other righl-of•way use hereto Tom/—� applied for and further agrees to remove same upon nolfre from the Approved to Construction Date CitM�� blit property dame thereby. oPrML INSPECT— ION Date `'c Approved as Constructed Signature of Applicant ate 11PI.VrettPUBLIC WORKS DEPARTMENT 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 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BEPhone: 259.8815 CANCELLED BYTHECITYUPONANY STOPPAGE OFWORKON THIS PROJECT OVER 90 DAYS DURATION.