4910 DOVER ST 2016-01-01 MF Import

�-18-91 �-3s-Zg-4 Date App�icdtion For PUBLIC WORKS PERMIT Print or Type Only TO POSTI NG s '�_ Pu�lic Worha Permil • J � l� / Biaa. oeot.. 91/273� Pu01ic Worka feo Tol�l Fee S _ Lesa ApP� Fee PaIE S Balence0ua S Z� Donald �obane SB15A Glenwood Everett 99203 355-9271 Owner Mai! .�g Address City Zip Phone rvianing Descrihe Proposed Work Project Address (if kaown) Zip Attach four (4) copies of ptans lor proposed work - Draw to scale and note !he following as applicable: • Property Lines • Centarline of street • Outline end dimensions of ail existing and • Indicate North proDosad structures on t:ie lot • Show any proposed grading changes • Ezisling and proposed utilities • Show measurements PERMIT CONDITIONS 1. All cells tor Inspection ahall be mede 24 hrs. in advance • phone 259•881 O. 2. All work shall be performed in eccordence with this permit and curi ent City of Everett Design and Constriction Standards and Specifications. 3. Cell Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800�4245555. � �u.�4 ��i� Qe `7-Zs-gl Appruved for Co�uction p��e __-'�/ G%[.°c'�c�---� � - / • g' z. FINAL INSPECTION Dnte Approved as Constructed �PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone:259•8810 ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any antl all claims for dameges, 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 lurther agrees to remove same upon notice Irom the City an to replace public pro ty d ma thereby. O Signa of App�icant Dat WORK AUTHORIZED BY THIS PERMIT A1UST dE 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.