5729 BEVERLY LN 2016-01-01 MF Import

Date� Applica�ion For PUBLIC WORKS PERMIT Print or Type Only �r. Describe Proposed Work Cuy v:�ei�� wa,xs vmmn . -- oiee o�ai . LZ/,�% Pu1�bc Worwy Fne s TO�II �p0 Less AOP� Pec Paie S Balanca Oue S 3ss-4`.S 7� Zip Phone '-7.Z0_i Zip Phone Prolect Address lil known) " "� " - Attach loui (4) �opies of plans for proposed work • Draw to scale and note the lollowing as applicahle: • Property Lines • Outlino and dimensions of all existing and proposed structures on ihe lot • Exislin� and proposed u�ilities • Centerline ol streel • Indicate Norih • Show any proposed grading changes • Show measuremenis PERMIT CONDITIONS 1. All calls lor Inspectlon shall be mede 24 hrs. in advance • phone 259•8810. 2. All work shall be performed in accordance with this permil and current City ol Everett Design and Consiruction Stendards and Specifications. 3. Call Location Undorground Service 4B hrs. before you dig. TOLL FRCE NUMBER 1-800•424-5555. c=/' i) ze�� «/' , ,�;;,�l�r� /�Y .r ,i :5'I Approved lor Conslruclion Dale FINAL INSPECTION Date Approved as Conslructed everett PUOLIC WORKS DEPARTMENT � 3200CederStreet Everett, WA 98201 Phone: 259�8810 ACKNOWLEDGEMENT OF CONDITIONS � O � � O a The undersigned owner/applicant hereby ag�ees lo hold and save harm� less ihe City ot Everett from any and all claims toi damages, cosls, expenses. or causes of action that may arise because ol installation and maintenance ol the improvement or other riyht-obway use herelo applied br and �urther agrees lo remove same upon notice from the City and lo replace public property damaged Ihereby. Signature ol Applicanl D�te WORK AUTHORIZ[D BV TNIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED i0 COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY S70PPAGE OF WURK ON THIS PROJECT OVER 90 DAYS DURATION.