17 76TH ST SE 2016-01-01 MF Import

Date J "' l�_`•�`�^ 1 Pebl¢Works Perm,l• � ��/ Application For rya Dept PUBLIC WORKS PERMIT PnbbcW F..Fea Tmn Fee S } Leu Fee Poe f int or Type Only J is S,� aslence ce D Due r N\ r ,�ryn[,t� � J/ Cr Owner NrnA[ , Jr8aey ni mg P namesdGuy ZIP y9 3JLS.� \ Phone Applicant Melling Address City Z'p Phone Describe Proposed Work?, Project Address(if known) Attach four 141 copies of plans for proposed ,pork• Draw to scale and note the following as applicable: • Properly Lines • Centerline of street — • Outline and dime isions Of all existing and • Indicate North Proposed structures on the lot • Show an • Existing and proposed util'.'es Y Proposed grading changes • Show measurements DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS 1.All calls Im inspe:Gori shall be made 24 hra.in advance•phone 259.8810. 2.Al!work shall be performed in accordance with this rarmlt and current City of Everett Design and Construction Standards and SPOClllcallons 3.Call Location Ulyderground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. O r� UO O a.. ACKNOWLEDGEMENT OF CONDITION'S The undersigned owner/applicrr,t hereby agrees to hold and save harm- �n,r less the City of Everett Iron any and all claims for damages, costs, ji/�[�.. J / expenses, or causes of action that may arise because of Installation yi! FCiL y/�0 and maintenance of the Improvement or other right-of-way use hereto Approved for Co sir ction �-/ Data A— applied for and IIrN er agrees to remove same upon notice from the City and to r f e rblic property damaged Thereby. FINAL INSPECTION Date (� Approved as Constructed Signature of ApplicantCk Dale r•vrrrrt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 3200 Cedar 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.