625 58TH ST SE 2016-01-01 MF Import

l iate...G_SCl/ Public Work,Permit Application For Bina poor PUBLIC WORKS PERMIT Pub lic wont Total rosfae 8 Les,Appt Fee P,lo S Balance Du, S Print or Type Only X? W203 J'J4//ZZ9 Owner Mailing Address City Zip Phone Applicant Mailing Address City Zip Phone Describe Proposed Work � W Project Address(if known) Attach lour(4)copies of plans for proposed work• Draw to scale and note the following as applicable: • Property Linea • Centerline of street ♦^ • 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 Th IS LINE O PERMIT CONDITIONS 1.All calls for Inspection shall be made 24 hrs.In advance•phone 259.8810. f� 2.All work shall be performed In accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800424.5555. O PUBLIC WORKS PERMIT NOT REOUIRED BY U) DATE O a L ass ACK14OWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm• less the City of Everett Irom any and all claims for damages, costs. expenses, or causes of action that may arise because of installation and maintenance of the Improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the ,roved Ior Construction Date Cly and to replace public properly damaged thereby. INSPECTION Dale ed as Constructed Signature of Applicant Gate WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Mr Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259.8810 PROJECT OVER 90 DAYS DURATION.