103 77TH PL SW 2016-01-01 MF Import

p Datg 4 S/I 3:- 4 9 Public Works Application For Bldg.Dept.is -SO PUBLIC WORKS PERMIT PubTo Woke Foe -- Tolyl Fee Q— Lett Xppl Fes Paid S Print or Type Only Defiance Due 5 o Bc Q/� �p'?I r-L.n:, Wvr T. /Z4. r v ,¢F 11w14i , Ea' 9j->004 JS7—//7 Owner Mailing AfJdrq:.; City Zip Phone Sj9nn t. Applicant Mailing Address City Zip Phone Describe Proposed Work S.•yG a zt.�y Ax1r. Project Address(it known) �U 1 m per• s-W� Attach four(4)copies of plans for proposed work-Drew to scale and note the following as applicable: • Property Lines • Centerline of street ♦A • Outline and dimensions of all existing and • Indicate Vorth Ch proposed structures on the lot • Show ani proposed grading changes • Existing and proposed utilities • Show m.•asurements DO NOT WRITE BELOW THIS LINE 0 PERMIT CONDITIONS 1. All cells lot Inspection shell be made 24 hra in advance-phone 269-8815. 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell Locatlon Underground Service 48 hra before you dig.TOLL FREE NUMBER 1•800.424.5555. r'. 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, coals, expenses, or Causes of action that may arise because of Installation `-/ 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 onslr ctlon Dale City and to replace public property damaged thereby. FINAL INSP TIO Date Z ) Approved as Constructed nature of Applicant Odle PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN evcrctt 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT.— 'S TO 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIt n .1 BE Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone: 259.8815 PROJECT OVER 90 DAYS DURATION. + I