4920 DOVER ST 2018-01-02 MF Import

I Pubt.c Works Perms S7 �q[16 Date! ( Bldg, Dept. --i Application For - PUBLIC WORKS PERMIT Print or Type Only City Owner Uty Describe Proposed Work Public Works Fee S — Total Fee leas Appr Fee Paid S Balance Due $ Project Address (if known) _ `—' Attach four (4) copies of pltns for proposed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimens!ons of all existing and proposed structures u•r the lot • Existing and proposed utilities • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements Phone 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 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 1.800.424.555 . f7 Dale Approved for GoCC FINAL INSPECTION Dale Approved as Constructed everen PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 98201 Phone: 259-8815 z O O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, ousts, expenses, or causes of action that may arise because of use ereto installationand maintenance of the improvement or other right-of-way applied for and further agrees to remove same upon notice from the Aignature place public property dam d thereby. ZS- Date Applicant 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.