102 79TH PL SE 2016-01-01 MF Import

,�1 .i �l PubM Works Permit Date, 91de Dept.e - Application For PUBLIC WORKS PERMIT public TWOFeFN Torr F" s Le"AppL Fee Paid 3 aelente Due $ Print or Type Only Air.26weeze M */T`,fCL- EC f4eg w7ry Aee )l 33-257`-3 Owner Ing Address Zip Phone :�r- ��/J'4— Applicant Mailing Address City ��'Zipp Phone L Describe Proposed Work » 'v'� Ale- tzg �� /o W Project Address(if known) Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: • Property Lines • Centerline of street p^ • Outline and dimensions of all existing and • Indicate North Y/ proposed structures on the lot • Show any proposed grading changes • Existing and p,oposed utilities • Show measurements M F DO NOT WRITE BELOW THIS LINE O t PERMIT CONDITIONS 1.All calls for inspection shall be made 24 his.In advance•phone 259.8810. Mi 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 his.before you dig.TOLL FREE NUMBER 1.800.424.5555. z O yPit) Cn 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-of-way use hereto applied lot and further agrees to remove same ripon notice from the Approved for Construction Date City and to replace public property damaged thereby. .. FINAL INSPECTION Date Date Approved as Constructed Signature of Applicant WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE:) WITHIN everetl 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:259.8810 PROJECT OVER 90 DAYS DURATION.