6309 HIGHLAND DR A&B 2016-01-01 MF Import

�7 �.-Cr -�:.8• s Date� -7�% Application For PUBLIC WORKS PERMIT Print or Type Only Applicant Describe Proposed Work ��-� A � � �P/,�l� Proleet Addreas (If known) PuoLcworwePermi � /O" eiaa Deoi. • - Pu�li< Worka Fee Tolel Fee = Lees AOV�. Fee Pai� S Bal�nce Due S Lp c�cy 309 A+a µ�c,H�� pZ. �� Atlech four (4) copiea of plens for proposed work - Draw to scale and note the following as applicable: • Propsrty Linea • Centerline of street • OutHne and dimensions of all existinq and • Indicate North propoaed atructurea on the lot • Show eny proposed grading chenges • Ezietinp and proposed utilitles • Show measurements PERMIT CONDITICNS 1. All cNls for Inepsction ahall be mede 24 hrs, in advance • phone 259�8810. 2. All work ehell bs pertormed in eccordance with this permit and curtent Ciry of Everett Design and Construction Standerda and Specificatlons 3. Cell Locatlon Underpround Service 4B hra before you dig. TOLL FREE NUMBER 1•500-4245555. �� r' 1� c'�, 2 2C� C� Approved tor Con truction a�e � // �d FINAL IN ECTI Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Sireet Everet� WA 98201 Phone: 259-BB10 ACKNOWLEDGEMENT O� CONDITIONS W � � � � O � � O a 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, or causes of action that may arise because of installation and mainle�ance of the improvement or other right•of•wey use hereto applied for and further agrees to remove semo upon notice from the Cily a d to replace pubiic property damaged thereby. ,�.� ,:J 2 - //- r � Signature of Applicant Date WORK AUTHORIZED THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAY BE CANCELLED BV THE CITY UPGN ANY STOPPAGE OF WORK ON TfiIS PROJECT OVER 90 DAYS DU�ATION.