1303 58TH ST SW 2016-01-01 MF Import

Date /� 1 Public Work$Permit a �/ i Q�� ING 6109 Oeol • Application For PUBLIC WORKS PERMIT Pub blic Works Total Feeise S Leu APPI.Fee Paid $ -- [51 sabots Due S Print or Type Only °; I� Q• .F E D�I� ��. 189/3F �-�`�� •� 1�A `jSDIZ 31(0-�6/ Owner Mailing Addre �' C_ r7 City Zip Phone P W W CJ r� W SAMA o ff ; Applicant Mailing Address City Zip Phone Describe Proposed Work f; r W Project Address(if known) 1 3 m Ayle 14J • 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 an the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements M DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1.All tails for Inspection shall be made 24 bra.in advance•phone 259.8810. 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3.Call Location Underground Service 48 bra.before you dig.TOLL FREE NUMBER 1.800.424.5555. Pte rcQnoti ptie".'c' �A t — O 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 installation and maintenance of the improvement or other right•ol-way use hereto applied for and further agrees to remove same upon notice from the ApprovQ for Con ti Date City and to replace public property damaged thereby. Z/--+ FINAL INSPECTION Dale Date Approved as Constructed Signature of Applicant WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN IrPUBLIC 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 Everett,WA 88201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS m7r Phone:259.8810 PROJECT OVER 90 DAYS DURATION.