109 77TH PL SW 2016-01-01 MF Import

/ S ^ Public Worts Perrmid N ✓ /�� Dete16 Bldg.Deol a Application 6or PUBLICWORKS PERMIT PuDbcWor*0 1< Toltl Fae Leu PPI Fee Paid s �•, Bnbnce Due S sy r D Print or Type Only 9d-2.1y 3tT—/�77 i Owner Melling Address Cdy Zip Phone S I S/fM1' Phone Melling Address City ZIp Applicant n Describe Proposed work S NL✓ Gam•• /ice(_— — -- W Protect Address(11 known) /09 7J Attach four(4)copies of plans for proposed work• Draw to scale and noto the following as applicable: • Property Lines • Centerline of street to Outline and dimensions of all existing and • Indicate North 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 calls for inspection shall be made 24 hrs. in advance- phone 259-8815. 2. All work shell be performed:n accordance with this permit and current City of Everett Onsign and Construction Standards and Specifications 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. ,S/eUL s�rE F.sx e �Qr ,l/ve y. O I _ (Zm2 N i O a ACKNOW..EDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damage& cost& expenses, or causes of action that may arise because of installation �—�/� i• �� S and maintenance of the Improvement or other righ4 n wilynoti 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. r � ` Vale FINAL INSPECTION Date Si ature of Applicant Approved as Constructed ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN everell 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 W Phone:2598815 ' PROJECT OVER 90 DAYS DURATION.