5010 DOVER ST 2016-01-01 MF Import

Date�� �T Appli�alion For PUQLIC WORlCS PERMIi Print or Type Only � Applicant no Address ling Describe Proposed Work !\ ��_�� Praject Address (if rtnown) ✓�� v�� �„��•��„sN�,m�, .�7—y7 Oldg. oeot • ��,� � Publlc Waks fec TottlFev $ — Less ApP� Fce Paid �u Bn�ance Oue 5 � �� Zip Phone Attach lour �4) copies of plans for p�oposed work • Diaw to scale and notr, the followir,y as applicable: • Property Lines • Outline and d�mensions of all exi;ting and proposed structures on the lot • Existing and proposed utilities Approved lor Approved as evr.rett �e PERMIT CONDITIONS � Centerline of sireet � Indicate North • Show any proposed grading changes • Show measurements i. All calls for inspection shall be made 24 hrs. in adva�ce - phone 259•881 5. 2. All work shall be perfoiined in accord�nce with this permit and current City of Everett Design and Consiruction Standards and Speci(icalions. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. ' oUBLIC VJORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phane:259•8815 ACKNOWLEDGEMC-NT OF GCNDITIONS � � � � O � � O a The under;igned owner/applicant hnreby agrees to hold and save harm- less the City of Everett irom any and all claims lor damages costs, expenses, or causes ol action that may aiise because of installation �J 87 and maintenance ot the improvement or other right�ol-way use hereto applied for and furth?r agrees to remove same upon nolice Irom the /Date City and to replace public properly damaged there�y. —� � , > � � G� / Date -f L/.r-�-� _ '� " 7 Signature of ApP�icarl{: Date VlORK AUTHORIZED 6Y THIS PERMIT MUST BE SiARTED WITHIN 180 DAYS OF DATE FERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT �.1AY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVLR 90 DAYS DURATION.