4 76TH ST SW 2016-01-01 MF Import

i i Date�. '.�,�/ P bhm Works Perrlld e I do Door e Ilpplicauon For ��. PUBLIC WORKS PERMIT Puri Turnork%Fee fee 6 — Leo Appt Fee Pad 9 blumce Due >< Print or Type Only Owner / Meiling Address dy Zip Phone Applicant Mailing Address City Zip Phone / Describe Proposed Work W Project Address III known) 76 11A Attach four(4)copies of plans for proposed work•Drew to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North • Show any proposed grading changes proposed structures on the lot • Show measurements • Existing and proposed utilities M DO NOT WI'ITE BELOW THIS LINE PERMIT CONDITIONS 1. All calls for inspection shell be made 24 fire.in advance•phone 259-8815. 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction Standards and Underground s.S 3, Call Location Underground Service 40 hra before you dig.TOLL FREE NUMBER 1.800.424.5555. ` x' Cn 0 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 and maintenance of the Improvement or other right-ol•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 Dete Signature of Applicant Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN evrrett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT 19 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 4 Phone:259.8815 PROJECT OVER 90 DAYS DURATION.