2032 HIGHLAND AVE 2018-01-02 MF Import

Date Application For PUBLIC WORKS PERMIT Print or Type Only Address Applicant City City Zip Public Works Permit • & .T— Zoo BIOa Dept e Punk Worlu Fes ` Total Fee Lsaa APp• Fee Paid i n Balance Due F13 W Project Address (if known) 0.3z Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: t• e Property Lines a Centerline of street • Outline and dimensions of all existing and a Indicate North proposed structures on the lot a Show any proposed grading changes e Existing and proposed utilities a Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs. in advance - phone 259.8815. 2. All work shall be performed in accordance with this permit and current City of Evf:rett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. n .1 u 0 IL ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses, c r causes of action that may arise because of Installation /, 27 85 and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the Approv�Joeleea ction Date City to replace public property damageo !hereby. .2 - —ate _ FI INSPECTION Date �/ r Approved as Constructed S' nature of plicant Date everett PUBLIC WORKS DEPARTMENT ORK AUT RIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone: 259.8815 PROJECT OVER 90 DAYS DURATION.