4914 DOVER ST 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address Describe Proposed Work Project Address (if known) Public Works Permit e 1 308— /r Bldg. Dept. a � ms Public Works Fee $ Total Fee Less APPr Fee Paid $ —� Balance Dun $ Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimer�ions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing sod proposed utilities • Show measurements Phone PERMIT CONDII IONS 1. All calls for inspection shall oe made 24 hrs. in advance • phone 259.8810. 2. A;I work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards aid Specifications. 3. Call Location Underground Service 48 hrs. befcre y.,u dig. TOLL FREE NUMBER 1-800.424.5555. g �a Approved for Cof structi Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett. WA 98201 Phone: 259.8810 _s.;'.."1'. v. ACKNOWLEDGEMENT OF CONDITIONS w Y Ch Im O z O 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. {� < o Signature of Applicamf 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.