5 76TH ST SE 2016-01-01 MF Import

I Joe>—I / Date_ Public Wode Permit mea Cecil a 9'O 12-6W4 Application For PUBLIC WORKS PERMIT Public Works lea Leu ePPI Pee PUE S Print or Type Only TO POSTING Beiarce Due S Z� Ll L r-oiy FiSrI� 5g2 ' CC�� LFy�2 T 9r3 2y 742-3 3(05 Owner Mailing Addi, City Zip Phone, Applicant Melling Address City Ln Phone Describe Proposed Work W Project Address(if known) ,h+ 0 'ZCipTH !Sr sE �.. Attach lour(4)copies of plans for proposed work-Draw to scale and note the following as applicable: • Prooerty Lines • Centerline of street /A • Outline and dimensions of all existing end • Indicate North v+ proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements AA DO NOT WRITE BELOW THIS LINE WO PERMIT CONDITIONS 1.All calls for inspection shall be made 24 bra.in advance-phone 259.8810. e\ 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 bra.before you dig.TOLL FREE NUMBER 1.800.424.5555. O Cl)Y/ 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 antl maintenance a Improvement or other right-of-way use hereto �' (C�� 3 _ �� applied lora rthe agrees to remove same upon notice from the Approved for Construct n Date City and to r PI e p Ilc property damaged thereby. FINAL INSPE TION Date Date Approved as Constructed Signature of plica WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN everett 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 Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259.8810 PROJECT OVER 90 DAYS DURATION.