1410 80TH ST SW NORTHSHORE CHRISTIAN CHURCH 2016-01-01 MF Import

Uate. _ T Application For / PUBLIC WORKS PERMIT Pvbftw`"4'. TO.f» F I.~'"N4 S_ N.O.M. s Print or Type Only Z�110 A//O -�O S� Sc•� C /1L� Owner Mailing Address City Zip Phone V _ T'/"e;?/" - -) 9) - 9o/S- APPlicant /��Maailing Address City Zip (/ Phone Describe Proposed Work &4e — -- — Project Adulate Of known) - - Attach lour 141 copies of plane for proposed work-Drew to sure and note the following as applicable •Property Lines •Cenlerline of street •Oullme and dimensions of all e.lsling and •Indicate North v, proposed structures an the lot •Show any proposed grading changes •Fiusling and proposed utilities •Show measurements DO NOT WRITE BELOW THIS LINE WO PERMIT CONDITIONS I.All sins for ll b inspection emelt in made an omit advance thane 2594881 O. Z.All work shall be performed In accordance with this permit and current City of Everett Design and Construction Standards and Speailicalans 0.Cell Location Underground Seivlcn AS him before you dog TOLL FREE NUMBER 1.800-424.5555. Z liasse a ACKNOWLEDGEMENT OF CONDITIONS The undersigned ownerlapplican!hereby agrees to hold and save harm. len the City of Everett from any and all claims lot damages costa expenses. or causes at action that may arise because of Installation and maintenance of the Improvement or other right-ol•way use hereto applied lot and further agrees to remove same upon notice from the Approved for Construction Date City and to repi public properly damaged thereby. FINAL INSPECTION Data Approved as Constructed ra of A Dale PUBLIC WORKS DEPARTMENT ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN PUBLIC RKSD ISO DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO Off ErarML WA 418201 t BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE Plane: WA E8t0 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 00 DAYS DURATION.