4932 DOVER ST 2016-01-01 MF Import

Date_ i�.�7 Application For PUBLIC WORKS PERMIT Print or Type Only � GJ �` �7- .5 `% ,D/� .S'.�. � 7 Address City Mailing cay Describe Proposed Work 'V ew -S� �I..��i� M� ��_�� p�'I �� Qr1 L.1� Prolect Address (if known) Public WarMs Permitl �� Bldp. Dept. e _ !S % / / 7/w. � % Pu�lic Wo�ks Fee ,o�a� Faa s _ Less Ao�� Fee PaiE S Balance Dua S �� � �� J `j 07�� Attach four (4) copies of plans for proposed work - Draw to scale and note the following as �pplicable: • Property Lines • Centerline of sireet • Outline and dimensions of all existing and • Indicate North proposed Structures on the lot • Show any proposed grading changes • Existing and proposed utilities � � Show measuremenis 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 Everntt Design and Construction Standards and Specifications. 3. Call Location U�derground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. FINA� Approved : everetc e PUOLIC WORKS DEPARTMENT 32Q0 Cetlar Street Everett. WA 98201 Phone: 259�8815 ACKNOWLEDGEMENT OF CONDITIONS W H � � � � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the Cily ot Everett lrom any and all claims for damages, costs, ezpenses, or causes of aclion that m.,y arise because of installation and maintenance of the improvement or ether righboFway use hereto applied for and lurth=r agrees to remove same upon notice Irom the City and to rPplace public proparty demaged the�eby. � 3 , ' Sig tur of Applicant :�ate WORK �UTHORIZED BY THIS PERMIT h7UST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT M17AY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.