2422 80TH PL SE 2016-01-01 MF Import

Date 8 Z Pupric WO Me Permit• g3 /�� Application For aao Dell PUBLIC WORKS PERMIT PVebe Won,I Nte Feerpe S�0. C30 — LestAppiFeePee S Bele,Due S Print or Type Only Cy/ 5'C- _ e., j3er, 179 :x8 L4 3'-!-' Ave Ari. 9'F22i 659 - Ii Owner Mailing Address City Zip Phone _ $rAV%e _ Applicant Mailing Add ess City Zip Phone Describe Proposed Work KS NC' F -- Lu Project Address til known) -- Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: IIID • Property Lines • Centerline of street ♦A • Outline end dimensions of all existing and • Indicate North v+ proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements �A DO NOT WRITE BELOW THIS LINE W^ PERMIT CONDITIONS V 1. All calls for Inspection shall be made 24 hrs. in advance- phone 259-8815. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1.800.424.5555. O O a 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 Irstallation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the r e er Construction Date City and to repla•.e public property damaged thereby. F AL INSPECTIONift ��-t'' Approved as Construct, Signature of Applicant Delo evemtl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS P MIT MUST BE STARTED WITHIN 3200 Cedar Street 180 DAYS TL DATE PERMIT IS ISSUED AND THEREAFTER IS UE Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY CIE Phone: 2598815 CANCELLED BY THL CITY CAPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.