2518 HIGHLAND AVE 2016-01-01 MF Import

r � � L Date S ► 3 Application For PUBLIC WORKS PERMIT Print or Type Only � ,3.30,�- �z��=' � Address City � PUCIIc Works Permit �� I� O BItlp.Dapt.• �Q�, PUEIic Wo�ka Fae Tolal Fee S Leea AppL Fae PaiU S T OS BalenceDue S �� � 6�a�i Phone �AmE /� S /�l3a ✓c Applicant Mailing Address City Zip Phone Dascribe Proposed Work Cn N_S � le U G f' NE k,� �1- A.Q A.- Pro�ect Address (if known) Attach four (4) copies of plans for proposed work • Draw to scaie and note the Iollowing as applicable: • Property _ines • Outline and dimensions of ell existing and proposed structures on the �ot • Ezisling and praposed ulilitias PERMIT CONDITIONS • Centerline of street • I�dicate North • Show any proposed grading changes • Show measurements 1. All calls for inspection shall be made 24 hrs. in edvance • phone 258•881 5. 2. All work shall be performed in eccordance with this permit and current City of Everett Design and Construction Stendards and Spedficetions. 3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 � Phone:259•8815 S ACKNOWLEDGEMENT OF CONDITIONS W H � The undersigned owne�/applicant hereby egrees to hold end aeve herm• less the City of Everett Irom any and all cleims for tlamapea coate, expenses, or causes of ection that may arise becauae of Inetallation _� end maintenence of the improvement or other righbof-way uae heroto applied for and further agrees to remove same upon notice from the Date City and to replace public property demaged theraby. o -�1 Date � Signeture o Applicent Det WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN 180 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 TliIS PROJECT OVER 90 DAYS DURATION. � � J �