1010 84TH ST SE 2018-01-02 MF Import

Date--S--13-94 Application For PUBLIC WORKS PERMIT Print or Type Only Ptlow wor4s Permil e Bide pool • ._-�j�F�•� Poblw Work% Fee s TMAI Fee 1e44 •Pal Fee NO S Belpre oun 5- Shirley Loth 1010 84th St SE Everett WA 98208 353-nAA7 phnn0 Owner A'.n.in.. "'Art SS k Gll� zip Owner _-------- -- Applicant Mailing Address Zip Describe Proposed Work Project Address (il known) .�O�Qy th_St_$$_____.___ -- - Attach four (4) copies of plans for proposed work - Drav: to ccdl-+ Will note the Oenlowing as of st Well able. • Properly Lines • Indicate North • Outline and dimensions of all existing and • Show any proposed grading changes proposed structures on the lot • Show measurements • E+isting and proposed utilities PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. In advance - phone 259.8810. 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. Approved for Construction PUBNCOT REDUIRED MIT 9Y GATE --- --- Dale FINAL INSPECTION Date Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8810 Z O 0 a ACKNOWLEDGEMENT OF CONDITIONS The, undersigned ownerlapphcant hereby agrees to hold and save harm- less Ihn City of Everett from any and as claims for damages. costs. evpenses. or causes of action that may arise because of installation and maintenance of the Improvement or other ngh4ol-way use hereto applied for and further agrees to remove same upon notice from the C,ty and 10 replace public property damaged thereby. Dnte Signature of Applicant RMIT MUST BE STARTED WITHIN 90RDAYS TOF DATE PERMIT ISHORIZED BY THIS ISSUED SSUED AND HEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.