11 77TH PL SW 2016-01-01 MF Import

nate Public Wodr Permit e X17—D r Bldg Dept_• —� Application For PUBLIC WORKS PERMIT Pebtk V6 otel Feeiae t{ — Less Appl.Fee Paid d eeleece Due f{ Print or Ty;e Only WwAM0CRA*11 aWA'"0400VS y462 R.23CO STSLO Mkr1-cewc WA - 775''y3al Owner Mailing Address City Zip Phone sArnr✓ Applicant Meiling Address City Zip Phone Describe Proposed Work Si .v rn II 77d� ISI SILK � luvfrr Protect Address(if known) 11 _2344 Attach four(4)copies of plans for proposed work-Drew to scale and note the following as applicable: sleta� • Property Lines • Centerline of street ♦^ • Outline and dimensions of all existing and • Indicate North Y proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE 0 PERMIT CONDITIONS ( 1. All tails for Inspection shall be made 24 hra In advance•phone 259.887 5. sal 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell LocaLon Underground Service 48 hr& before you dig.TOLL FREE NUMBER 1.800.424.5555. z O FM C0 0 am p �r ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant heroby agrees to hold and save harm- less the City of Everett from a.;y and all claims for damages, costs, expenses, or causes of action tha'. may arise because of installation and maintenance ofthe Improve en or mother rlght•ol•way use hereto applied for and further agrees remove same upon notice from the ApproveCons for ru t C Date City and to replace public pr p damaged thereby. f� i. � 3—2/• r7 F �V / FINAL INSPE ION Date at Approved as Constructed Signature of Appl ant WORK AUTHORIZED BY THIS PERMIT MUST BES ART WITHIN everett 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 Phone:259.8815 PROJECT OVER 90 DAYS DURATION.