5004 DOVER ST 2016-01-01 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only AP{ Describe Propuszd Work �� 15�� Pro�ect Address (if known) � �U � —' Zip Attach four (4) copies ol plans for proposed work - Oraw to scale and note the following as applicable: • Property Lines • Outline end dimensions of all existing and proposed structures on the lot • Exiating end proposed utilities 87 � �-3 Pu01i< Works Pe�mit � BICp. UBPt. a �� Public Wurkn Fae TaIalFen S Lese AppL Fee Paitl S Balence Due S �� • Centedine of street • Indicate North � Show any proposed griaing changes • Show measureme�its Phone PERMIT CONDITIONS 1. All calla for Inspection shall be madg 24 hrs in advence • phone 259•881 5. 2. All work shell be performed in eccordance with this permit and current City of Everett Design and Conslruction Stenderds and Specilications 3. Call Location Underground Sorvice 4B hrs. before you dig. TOLL FREE NUMBER 1-800•424�5555. � �/ �� Approved for Constr c' Date �� FINAL INSPEC ION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett WA 98201 Phone: 259•A?15 ACKNOWLFUGEMENT OF CONDITIONS � � � � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett irom any and all cleims for damages, costs, expenses, or causes of action that may arise because ol instellatien and maintenance of the iinprovement or olher right•of-way use he�eto applied for and furiher agrees to remove same upon notice from the City and to replace publi�perty damaged thereby. � _ � z�3-� � S' atu e of Applicant Date WURK 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 WORI< ON THIS PROJECT OVER 90 DAYS DURAT�ON.