16 76TH ST SW 2016-01-01 MF Import

i Date Nbfc Works Perms• Bide Door 0 Application r .,r PUBLIC WORKS PERMIT P°°To:Foe >< Leesvat Fes Ped 1{ Balance 0ee S Print or Type Only l '01(,OArL �`F:�.� l(Q- ��a �`F fCi) jakrp* �JF20'6 Owner —�� Mailing Address City Zip Phone �— Vin--p 1,14 7�, Lnn,b�,* 9k2D/ a 5a—,C3�i Applicant Meiling Address p� �� C ty Zip Phone Describe Proposed Work Lill) 1 c 'KJDT d•VYI, Q�tA6 W Project Address lit known) 46— Attach four(4)copies of plane for proposed work•Draw to scale and note the following as applicable: • Property Lines • Centerline of street ♦A • Outline and dimensions of all existing and • Indicate North v+ proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1.All cells for Inspection shall be made 24 hra.In advance•phone 259.8810. arts") 2.NII 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 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555, EE!P j Oi a ACKNOWLEDGEMENT OF CONDITIONS The undersigned ownertapplicant 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 ir•staltation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the Approved for Construction Date City and to replace public property damaged thereby. FINAL INSPECTION Date Approved as Constructed Signature of Applicant Date PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS t0 3200 Ceder 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:259.5810 PROJECT OVER 90 DAYS DURATION.