5028 DOVER ST 2016-01-01 MF Import

Date��% Applica�ion For PI�BLIC WORKS PERMIT Print or Type Only fi'� ��,Y pescribe Proposed Work �; v�� J� 7�� Pro�ect Address (if known) J UG�7 � UOtiE�' J i_ _ Attach lour (4) copies of plans for proposed work • Draw to scale and note the t��ilowing as applicable: • Property lines • Outline and dimensions of all exis�ing and proposed struclures on the lol • Ezisting and proposed utilities Cubl:c Wurks Peemif + �" / / 8109.DePt. • , ` � Pu�lic Works Fee T0191 Fe0 S - loss A00� Fae Paid S_—z.�-- eeiance oue S GQ SC" � Cnnterline of street • Indicate North • Show any proposed grading chnnges • Show measuremenis 3 �;-�-C�� Pnoue tl,; PERMIT CONDITIOYS L All calls for Inspection sha�l be made ''`•^ ir ^�'.._,-,,,e - phone 259•881 5. 2. AII work shall he performed in accordance �.. � ihis permit and curreM City of Everett Design end Construction Stenderds and Specificationa 3. Call Location Underqround Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. %i,S,NT- Li.u� T,vF B9c.t` ,�DoF t��PA��S T �'qu�.vE yT d{ %NF LOT Approved as Consvactad everett PUBLIC WORKS DEPARTMENT � 3200 Ce 'ar Street Evarett, �JA 98201 Phone: 259�8815 ACK�JOWLEDGEMENT OF GONDITIONS � O � � 0 a The undersigned owner/applicant hereby agrees to hold and save harm• less ihe City of Everett irom any and all claims for damages, costa expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of•way use hereto applied lor 2ncf lurther agrees to remove same upon notice Irom tha City and to replace public property damaged ttiereby. ig ature cl App t Date WORK AUTHORIZED BY THI PERMIT MUST BE STARTED WITHIN 100 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTFR 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.