2609 81ST PL SE 2018-01-02 MF Import

Date 3/5/84 Application For PUBLIC WORKS PERMIT Print or Type Only PublicWorFe Permd • O 8n1 079 Bldg. Dept e - Public Works Fee S 2-0,lop Total Fee -i Lee. •ppk Fee Paid $ Balance Due YaO ¢rO AW 3 Duane Berg 2704 128th Street S.W. Everett 98204 353-6229 Owner Melling Address City Zip Phone Same Applicant Melling Address City Zip Phone Construct Single Family Residence Describe Proposed Work Project Address (if known) r2 L SE Attach !our (4) copies of plans for proposed work - Drew to scale and note the enterline of oing as applicable: • Property Lines • Indicate North • Outline and dimensions all existing and • Show any proposed grading changes • Existing andd proposed utilities proposed ne the lot • Show measurements ro PERMIT CONDITIONS 1. All cells for Inspection shell be made 24 hrs. In advance - phune 259.881 5 2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell Location Underground Service 48 hire. Lefore you dig. TOLL FREE NUMBER 1.800.424.5555. ACKNOWLEDGEMENT OF CONDITIONS W H sts>• N Im 0 0A1h O a 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 malntenunce of the Improvement or other right-of-way use hereto applle end further agrees to remove same upon notice from the II D a CI end to place public property damaged thereby. S131I84 3A,Ar Approved as Constructed v 1 WORK AUTHORIZED BY THIS PERMIT MUST ARTED WITHIN everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUE D THEREAFTER IS TO 3200 Ceder Street BE DILIGENTLY PURSUED TO COMP TION. THIS PERMIT MAY BE Everett, FJA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORM: ON THIS Phone: 259.8815 PROJECT OVER 90 DAYS DURATION. i