2430 80TH PL SE 2016-01-01 MF Import

Datejj f 3 PuPMCWomsPerm"e Application Foy Blap DIPL e_ PUBLIC WORKS PERMIT PubkWorMeFee Tm_I Fee { Lae APDL Fee P.lo Print or Type Only seleft.Due C3 �;y96F ,/�1HeS 7 Q LM a7�y-/ F�` S c• /- V �i� 9��a q 3 S - a ` c Owner Meiling Address City Zip Phone _C/g/r/_ Applicant Mailing Address City Zip Phone Describe Proposed Work S rrZ UJ Project Address(if known) Zq 30 0 + P1 . S E FM Attach four(4)copies of plans for proposed work- D,aw tc scale and note the following as applicable: • Property Lines • Centerline of street ♦A • Outline and dimensions of all existing and • Indicate North v� proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs. In advance-phone 259-8815. tam 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. G CIO I�r 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 Installation and maintenance of the improvement or other right-of-way use hereto appke&for and further agrees to remove same upon notice from thn oprrr—ovffor_Construction U41te Ity e o replace public property damaged thereby. FINAL INSPECTION Date Approved as Constructed SlatrMture of Applicant Date Pverett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST B RTED WITHIN 3200 Ceder Street 180 DAYS OF DATE PERMIT IS ISSUED HEREAFTER IS TO Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPILE N.TIfIS PERMIT MAY BE Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.