108 61ST PL SE 2016-01-01 MF Import

Date-L:-:_41 -9C l Publ¢Vil Permd a Application For Bldg Dil a nw7-- 933 PUBLIC WORKS PERMIT Pubo,Il Fee Fee t Leer APPI Fee Paid t{ Print or Type Only Balance Due NOfLTH C—Remtal fi e-cep. j(a7.1Z :itrPH6t1.\�rf�Y SE �rF17t.9 MIL� GRG>_rc, Owner Mailing Address Clty Zip Phhone980�7.. 3313-14Bc. Applicant Mailing Address City Zip ---- Phone Describe Proposed Work WSW $INCIL.f3 ��MIt_\' (LesIOc3F.Y� Project Address(if known) tT PL.$E W Attach four(4) .:DPies of plans for proposed work-Drew to scale and note the following as applicable: 1 • Property Lines • Centerline of street • Outline and dimensions of all existing and 0 Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements M DO NOT WRITE BELOW THIS LINE W PERMIT CONDITIONS O 1.All calla for Inspection shall be made 24 hrs.In advance-phone 258.8810 2.All work shall be performed in accordance with this permit and current City Or Evere�l Design and Cnsr xilon Standards and Specifications. all 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER I.8L%"2*A &-19FN OOOR# # D024913 z 4.ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVED BLDG $599.00 BY THE PUBLIC WORKS INSPECTOR. FLW 165.00 5.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. HECH 3110.00 13.KEEP CITY STREETS CLEAN AT ALL TIMES. D SRCH $4.50 7.ANY DAMAGE TO THE CURB AND SIDEWALK WILL BE REPAIRED okl `L0•00 /A TO THE SATISFACTION OF THE PUBLIC WORKS DEPT. 000006962 Vd OTER $60.00 A #00027089 `� SEWER 130.00 A END I $110.00 lir 1171-5 $813.01) al CHER' $1811.50 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the Cny of Evcrell from any and all claims for damages. coals, expenses. or causes of action that may arise because of installation �a,Q Y� -7_ 9_� antl maintenance r! the Improvement or other right-of-way use hereto Approved for Construction Date apphad Idr and further agrees Io remove same upon notice from the City and to replace�ubfic property damaged thereby. FINAL INSPECTION Approved as Constructed Dale Signature of Applicant IZDate'� everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 3200 Ceder 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:259.8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. I.