1825 HIGHLAND AVE 2016-01-01 MF Import

W � . . - +iJr. Application For PUBLIC WORKS PERMIT Print or Type Only �. Pu�btWorknPe . 89- �9s eine �eoi. + PuEbc Worka fea Totnl Fee S lesa rlou�. Fee Paia S Balancn0ue s 20� Applicant Mailing Address City 2�p Phone Describe Proposed Work Prolecl Add�ess pf known) Attach four �4) copies of plans for proposed work - Draw to scale ano note the loltowing as applicable: • Property Lines � Cenlerline ot street • Outl�ne and dimensions ol all existing and • Indicate North p�oposetl atructures on tAe lot • Show any proposed grading chenges • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for inspectton ehall be made 24 hrs. in edvence - phone 259�881 O. 2. All worlc shell be performed in accordance with thia permit and curtent City ot Everett Design and Conshuctlon Standerds and Specificatlona 3. Call Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-4243555. ��;1l2� �ia�L 8 /f�� Approved for Constr cti n Date _J�� r/� sv FINAL INSPECTION Date Approved as Construcled everett PUBLIC WORKS DEPARTMEN7 � 3200 Cedar Sireet Everet4 WA 98201 Phone:25&8810 ACKNOWLEDGEMENT OF CONDITIONS W H � The undersigned owner/applicant hereby agreas to hold and save harm• less the City of Everett from any and all claims lor demages, costs, expenses, or causes of action that may erise because ol installation and maintenance of the improvement or other righl-of•way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. � -,,� S gnature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVEfi 90 DAYS DURATION.