104 79TH PL SE 2016-01-01 MF Import

Date--C? t l NbLc Work.Ferrer. Bldg Dept — Application For PUBLIC WORKS PERMIT PueTo W WoreeFes TOFee f Lees spot Fee Paid S—_ aeunce 0ue Z Print or Type Only �,A0eS.>u Io��rr0os� , 10 ' c1J�r 9W03 `f1?0 Owner Mailing Address City Zip Phone Applicant Mailing Address Ll City Zip Phone Describe Proposed Work v4 F)'X/ _ W 0q-AtProject Address(if known) 10q- Attach tach four(4)copies or plans for proposed work- Draw to scale and note the following as applicable: • Property Lines • Centerline of street ♦A • Outline and dimensions of all existing and • Indicate North vd proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements M DO NOT WRITE BLWW THIS LINE O PERMIT CONDITIONS i. All calls for inspection shall be made 24 hisin advance-phone 259-8815, 2. All work shall be performed in accordance with this permit and current City of Everted Jesign and Construction Standards and Specifications. 3. Call Location Underground Service 48 his. before you dig.TOLL FREE NuM6'ER 1•800-424.5555. V Ufife, c Q� �b ,r ►0 ' 0 � � Q "LKNtIWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm less the City of Eve,ett from any and all claims for damapes. 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 for and further agrees to remove same upon notice from the Approved lot 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 STARTED WITHIN D 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.