27 76TH ST SW 2016-01-01 MF Import

.v" . / 1 Date, � Pveee wore Permn. � e.ng Dep,• -S b/ /rJ Application For PUBLIC WORKS PERMIT Pee To Fee , Less App,Fee Pe.E f Print or Type Only 9e1enee D.e f i 1 X /�, H LAI rnirtl /1/ 1 9 R0 i '35/yi 3 Owner Malllnp Address City Zip Phone h. tf Isar / !ri1 L 9(a G6 F✓Nie/PPii /1 ' F i--MP// 9d01G3 953 - 7/6/ Applicant Mailing Address City Zip Phone Describe Proposed Work -i .z ui Project Address fit known) L Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and prcpred utilities • Show measurements DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS O 1. All calls for Inspection shall be made 24 hrs. in advance- phone 259.881 b. 0 2. All work shall be performed in accordance with this permit and current City of Everett Desig,and Construction Standards and Specifications. 3. Cell Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1.800.424.5555. z - f/- 0 /P ) L M 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 and maintenance of the improvement or other right-of-way use hereto Approved for Construction Date applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. i FINAL INSPE(.i.ON Date _ Approved as Constructed Signature of Applicant Date everett PU9LIC 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: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.