405 58TH ST SE 2016-01-01 MF Import

I PaM2Wnrx,P 7T) Application For Bldq OePr PUBLIC WORKS PERMIT PdhtdrNs4Fee Fee $- -- Lew AnPi fee Paid S _ Print or Type Only exlenc�Due s 14QIo ►'Y dJaq LinwoodgW-7 Owner 7 Mailing Address City Tip Phone 7149- 66� Applicant Meiling Address City ;,to Phone Describe Proposed Work Project Address(if known) �OS.._ s8S .S� — W Attach four 141 copies of plans for proposed work•Draw to scale and note the following as applicable: rl� • Property Lines • Centerline of street ,n • Outline and dimensions of all existing and • Indicate North v+ proposed structures on the lot • Show any proposed grading changes • fixisong and proposed utildics • Show measurements DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS 0 1.All calls for inspection shall be made 24 his.in advance•phone 259.8810. 2.All work shall be performed In accordance with this permit and currenl City of Everett Design and Construction Standards and Specifications. 3.Call I ocation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. z 0 N 0 ACKNOWLEDGEMENT OF CONDITIONS ' The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and a'I claims for damages. costs. expenses. causes of action that may ansa because of installation andmaintenance aintinlenence of the iroprowment ^r other nphl•nl•way use hereto applied for and further agrees to remove same upon notice from fife Approved for Conslr fon > Dale City and to replace public property damaged thereby. p/ FINAL INSPECTION QDale 'MA z /�.N'� '�-'� r r Q ✓J /Z// 9 Approved as Constructed Signature of Applicant Date everr•tt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 3200CetlarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Everett, da BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE 8 tree Phone:288.8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.