15 FERN RD 2016-01-01 MF Import - Laserfiche WebLink

DateJ�(>� �""', Application For PUBLIC WORKS PERMIT Print or Type Only J Publ¢WorksPar 4• � '�-^^��%�{'� BICIg.0e0�� •_. ' • , ^�� -- Pu�hc Wnrks Fee lotai Fee S _ Less Ano�. Fee PaiO S 6alanr.e Duo S 6wner Mai{ing Address City � Zip Phone Project Address (if known) Attach tour (4) copies of plans for proposed work - Draw to scale and note the fo�lowing as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on ihe lot • Exlsting and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS t. All calls for inspection shall be made 2a hrs. in advance - phone 259•8810. 2. AII work shall be performed in accordance with ihis peimit and current City of Everett Design end Construction Standarda and Specifications. 3. Call Location Underground Service 48 hrs. before you dlg. TOLL FREE NUMBER 1-800•424-5555. �C�� Jo��. �'�:fir�.��:,,� Approved for Construction FINALINSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMEN7 � 3200 Cedar Streel Everett, WA 98201 Phone:259•8810 Date Date � 88 ACKNOWLEDGEMENT OF CONDITIONS W H � � O � � � a The ur�dersigned owner/applicant hereby agrees to hold and save harm- less tl,e City of Everett Irom any and all claims tor damages, costs. expenses, or causes of action that may arise because of installation and maintenance of Ihe imp�ovement or other right-of-way use hereto applied for and further agrees to remove same upon notice Irom the City and to replace public property damaged thereby. Signature ol Applicanl Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM�T MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.