4814 DOGWOOD DR 2016-01-01 MF Import

Date� � �>� / Application For PUBLIC WORKS PERMIT Print or Type Only Owner Mailing Address Describe Proposed Work . l Pu�bc Wor�.. Pennit � ` t��' ` nmo Dco�. • ' PuUI�¢WorksFee 5 Talol Fee Less Appl. Feu Paitl S ealance Duo g _ 2 ��ar-��4 �'�� ' City Zip Phone ��r��i �� 3� �a�� City 2ip Phone Pro�ect Address (if known) " < < �� —� -�LU� � Altach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Centerline of sireet • Indicale North • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs in advance • phone 259-881 5. 2. All work shall be performed in accordance with this permil and current City of Everett Design and Construction Standards and Specilications. 3. Call Localion Underground Service 48 hrs. belore you Aig. TOLL FREE NUMBER 1•S00•424•5555. /UD �U�G /� LtJD�...�5 ��'�'/�-JiT Approved for Construction FINAL INSPECTION Approved as Constructed � evemtt PUBUC WORKS DEPAF'�IdENT � 3200 C ��dar Street Everet6 WA 98201 Phone: 259�8815 '/E9L'//'� �-c��O1 C '_/�7�'��' G/ . �� 7 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a Tho undersigned owner/applicant hereby agrees lo hold and save harm• less ihe City of Everelt Irom nny and all claims for damages, cosis, expenses, or causes ot action that may arise because of insta�lation and maintenance ol lhe improvement or other rigM-ohway use hereto applied for and lurther agrees to remove same upon notice trom the Date City and to replace public property damaged thereby. Signature ot Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTEP IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY Tti[ CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.