5807 LOWELL RD 2016-01-01 MF Import

DateCf�L _�� Application For PUBLIC WORKS PERMIT Print or Type Only [ip Pu�licWorksPermily �/ _�aO u Biaa. Dept y V auei�c Worxs Fee iotal Fee s LessFO�l. Fee Pai� S BaianceDue S +�� :'hone Describe Proposed Work Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed s�ructures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measuremenis PERMIT CONDITIONS 1. Ail calls for inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All work shall be performed in accordance with this psrmit and current City of Everett Design and Constiuction Standards and Specitications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. 6K' v �1 ev�� % 9 86' Approved for Consiru � n Date .,-'S��_ .�i' /- �� FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT �� 3200CedarStreef Evere��, WA 98201 Phone: 259�B81n ACKNOWLEDGEMENT OF CONDITIONS W H � The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims lor damages, cosis. experses, er causes of action ihat may arise because of installation and maintenance of ihe improvement or other iight-of-way use hereto applied for and luriher agrees to remove same upon notice Irorti the Ciry and to replace public properry damaged ihereby. �D _ L /0/�y_/�s� ign ure ot Applicant � Date WORK AUTHOqIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVEF 90 DAYS DURATION.