4902 FOREST DR 2016-01-01 MF Import

-i r �' �•at(�a �U � ^ Public Worke Parmil• Application Por eieg.oeo�.•��a � PUBLIC WORKS PERMIT PubTatelFaeFae s less Appt Fee PBitl S Balance Oue S Print or Type Only CY'IAJ 7'f�� S�41 � �� oRPsl` �l2 ��03 o7S%- 5�� Own�fr �' Mailing Address City Zip Phone z �M� o Applicant Mailing Address City Zip Phone � m Describe Proposed Work _Q�SL�` 'P`" R ��n/ � b e d��o�,.r M M 1 � .. -a �' m W R'n Project Address(if known) � o � Attech four(4)copiea of plans for proposed work- Draw to scale and note the following as applicabie: � i —=1 • Property Lines • Centerline ot street � m • Outline and dimensions of all existinp and • Indicate Norih �_ . proposed structures on the lot • Show any proposed grading changes � _ • Existing and proposed utilities • Show measurements /� .+ .-� � -1 N � DO NOT WRITE BELOW THIS LINE � p PERMITCONDITIONS O � � 1. All calls for Inspection shall be made 24 hrs in advance• phone 259-881 5. _ 2. All work shell be pertormed in accordance with this permit and current City ot Everett Design and Construction � o ! ' Standards end Specifications �o,� m 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � mN 1 �10 �S O � a � � �o � 1�`��, p � .d, �e �u��` � a ��'"" V� � � w� ��"" � � Z ��o .�/Y� a � / m r ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hoid and save harm- less the City of Everett from any and all ciaims for demages, costs, expenses, or causes of action lhat may arise because of instaltation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice (rom the Approved for Construction Date City and to replace public property damaged thereby. FINAL INSPECTION Date Approved as Constructed Signature of Applicant Date everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAY BE EveretL WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone: 259-8815 PROJECT OVER 90 DAYS DURATION.