5910 BEVERLY LN 2016-01-01 MF Import

Date Application For PUBLIC WORKS PERMIY Print or Type Only Puolic worxs rermJ . Diaq. oeo�- � — a�euc wa�xe rea s Tolal Fee leea A00� Fea Pai� $ — Balence Oue g J� ,� CdY Gip rnune Describe Proposed Work � • jT�� Prolecl Address (II kn. ++n) -� « � '� �—� - nuach four (41 cooies of plens lor piopoced work • Draw to scale and note the following as applicable: • Property Lines • Outline ard dimensions ot all existing and proposed �tructures on the lut • Existing and proposed ulilities • CeNerline ol street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls ler inspection shall be mede 24 hrs h� nd•.•ar.ce - phone 259•881 5. 2. All work shall he perlormed in acc�rdance wilh thls permi' and currenl Cily of Everett Design and Construction Standerds end Specilications 3. Call Location Underground Service 48 hrs. before you dig. TO:L FREE NUMBER 1-800-424•5555. y � � � /1/� � � �-�� 'C� . � . �� Approved Wr Construction Date FINAL INSPECTION Date Approved as Cunshucled everett PULLIC WORKS DEPAaTMENT � 3:00 Cedar Street Evere�t, WA 90201 Phone:259-8815 ACKNOWLEDGEMENT OF GONDITIOPIS � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm� less ihe City ol Everett from any and all claims for damages, cosis, expenses, or causes ol action that may arise bocause ol installalinn and main�enance ol ihe improvement or other riflht�ol�way use herelo applied lor and lurther agreo:: to remove same upon notice Irom ihe Ciry and lo replace public propi•rly damaged thereby. Signature ol App icant Date WOF�K AUTHORIZED BY ThiIS PERMIT MUST 6E STARTED WITHIN 180 DAYS OF L�ATE PERMIT IS ISSUED AND THEREAI=TER IS TO BE DILIGENTLY °UPSUED TO COAIPLETION. THI."i PERtv11T MAY BE CANCELLED BY 1 HE CITV UPON ANY 5T0('PAGE OF WORK ON (HIS PROJEC7 OVER 90 DAYS DURATION. .. ..� --I �1 .-i —� N 2 m co m� O 3 m _ -�i m «. cZ r = �. .. —1 N < '�7 O A �1 D -� m x mN �m c v+ 3 tn m z �� �m � _ a z � � � Z 0 � n m