407 72ND ST SE 2018-01-02 MF Import

'oate��s� I Aoplication For PUBLIC WORKS PERMIT Print or Type Only runes Wore•P • t nWp Dept. • (}.r/—�. r. ok Won• ree Toth Fee 6 L as$ April Fee Peed 6 _ Blaine'. Due 6 20eC ! ILo4) jc E'Lr& q Owner Mailing Address City Zip 27Phhone r 3 7 /`?!5 Applicant Mailing Addrreesss� City/ /Zip Phone Describe Proposed Work' W Project Address of known) y07 - 77'2dst, SE_ Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: r_ • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North L/ proposed structures on the lot • Show any proposed grading changes • En51mq and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE 0 PERMIT CONDITIONS 1. All calls for Inspection shall be mode 24 hrs. 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 hrs. before you dig. TOLL FREE NUM BER 1.800.424.5555. z FM 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. casts, expenses, or causes of action that may arise because of Installation and maintenance of the improvement or other right-of-way use hereto 1\fI_! ✓ !O r?L applied for and further agrees to remove same upon notice from the Approved for Cona uctio oale City and to replace public property damaged thereby. FINAL INSPECTION Date'�'1'e, IZ' Approved as Constructed Signature or Applicant I Date everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 32DO Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone: 259.8810 PROJECT OVER 90 DAYS DURATION.