5128 DOVER ST 2016-01-01 MF Import

oace3- �-g -S�r Application For PUBLIC WORK;S PERMIT Prinl or Type Only Publ¢ Worke Permil • Q��_ �� PIEp Dept e __p�� Pu�lic Woikf Fea s Totel Fea Less AppL Fea Peld S Bnlnncx Due S �Q� ppv� '�Ac.�so� /vsy N. �ae,� �P. ��` ygZo3 ��5�- �9So Applicant Mailing Address City Zip Phone Pro�ect Address (if known) ,4ttach four (4) copies of plans for proposed work • Draw to scale and note ihe folluviing as applicable: • Propnrty Li�es • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS • Centerline ol street • Indicate Norih • Shew any prpposed grading changes • Sho.v measuraments 1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shall be pertormed in accordance with this permit a�d current Ciry of Everett Design and Construction Standerds and Specifications. 3. Call Locat�on Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. C7�Gr,� �-�.�e�— 5��'6 Approved lor Construction � Date _�/�%/— �i -�L FIN INSPECTION Date Apprcved as Constructed everen PUDLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone:259•8815 ACKNOWLEDGEMENT JF CONDITIONS � � � � O � � O a The undr.rsignetl owner/applicant hereby agrees to hold and save harm- less Ihe City of Everett Irom any and all claims tor damages, costs, expenses, or causes ol action that may arise because of inctallation and mcintenance ol the improvement or other right-ol-wa�• use hereto applied for anA IurtLer agrees to remove same upon notice irom the City and to replace ��ublic pr p rty damaged Ihereby. � �� Wr'r,�� s�� ,L-�Y ignaWre ol AppliCunt Date WOFlK AUTHORIZE'J BY THIS PERMIT MUST BE STARTED WITHIN 7B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLFTION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI� PROJECT OVER 90 DAYS DURATION.