318 77TH PL SW 2016-01-01 MF Import

Date-2/ I r Pv01w Work$P n Bldg pair a Application For PUBLIC WORKS PERMIT PueToati $ Leu APO Fria Paid 5 ansnco Me S_ PrintorType Only y� -3 7 -aJV Owner Mailing Address City Zip Phone 1Appliean� Mailing Address City 21p Phone Describe Proposed Work W Prosect Address(11 known) 7? IMM Attach lour(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 CIO proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements /1A DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs.In advance•phone 259-8815 al 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. z O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/appllcanl 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 righhol•way use 'ereto applied for and further agrees to remove same upon notice from the Approved for Construction Dale City and to replace public properly damaged thereby. FINAL INSPECTION Date Dete Approved as Constructed Signature of Applicant PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN everett 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 TI IE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259.8815 PROJECT OVER 90 DAYS DURATION.