4708 DOGWOOD DR 2018-01-02 MF Import

Date Application For PUBLIC WORKS PERMIT Print or Type Only Public Works Permit Bldg DePL a Public Works Fee $ Total Fee — Less APPI. Fee Paid 5- --- Balance Due a Owner Mailing Address City Zip Phone Applicant Mailing Address L.nY Describe Proposed Work L Protect Address lit known) _ - ' � - -- Attach four (4) copies of plans for proposed work -Draw to scale and ote the following of applicable: • Property Lines •Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed gradirz changes • Existing and proposed utilities • Show measurements inn binT WRITF RFLOW THIS LINE 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 FINAL INSPECTION Approved as Constructed i PUBLIC WORKS DEPARTMENT Ever tt,WACedaStreet Everett, WA 98201 Phone: 259-8810 Date ACKNOWLEDGEMENT OF CONDITIONS W H in O n z O N N O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs. expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Signature A Applicant 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 PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.