5110 DOVER ST 2016-01-01 MF Import

DsteiQ�$1�6 Applica�ion For PUBLIC WORKS PERMIT Print or Type Only Mailing AdAress Describe Proposed Work _.�.Q�j..��ruC / UI/ll/ ..� Prolect Address (if known) 'S� Si_ Pu�Lc Woiks Permit • �� _ ` �� Blee. De01. • �r(��j„7�% % .�� Pu�6cWo�ksFbe S Tol fl Fao �ess ROG�. Fce Peid $ Balento Due S �� Zip Phone /3 Attach four (4) copies ot plens lor proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerlin� of street • Qutline and dimensions of all existing and • Indicete North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measureinents PERMIT CONDITIONS Phora 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shali be performed in accordance with this permit and current Ciry ot Everetl Design and Construction Standards and Specifications. 3. Call �ocation Underground Service 48 hrs. belore you dig. TOLL FREE NUM9ER 1-800•424•5555. �� ~ �� Approved lor Construction ' Date FIMkC1NSPECTION ' Appraved as Construcled everett PUBLIC WORKS �EPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259-8815 _'-/' � Date ACKNOWLEDGEMENT Of CONDITIONS W � � � � � a The undersigned ownedapplicant hereby agrees to hold and save haim- less the City ol tverell trom any and all claims for dnmagrs, ccsts. expenses, or causes of action that may arise because ol installation and mainlenance ol the improvemen( or other right-Of•way use hereto applied lor and lurther agrees to remove same upon notice Irom the Ciry and to replace public properry da �-� , ,�,�� o ignalure f App icanl Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS UF DATE PERMIT IS ISSUED A�� THERC-AFTER �S TO BE DiLIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAV BE CA,JCELLED BY THE CITY UPON ANY STpPPAGE OF WORK ON THIS PROJECT OVER 90 OAYS DURATION.