7125 HIGHLAND DR 2016-01-01 MF Import

Date �Z5—�"�' AGplication For PUBLIC WORKS PERMIT Print or Type Only Applicant Describe Proposed Work Project Address (il k�� vn) _ Mailing Mailing Address Attach lour �4� .:opies of plans lor proposed work - Draw to scale and note the tollowing as applicable: • Property Lines • Outline and dimensions ot all existing and proposed slruc!ures on the lot • Existing and proposed utilities PubLc Works Peimil y �`�' �`� D eide� oeoi� + —�t�� PubLc Works Fee Total Feo $ Lass Appl Foo Paid $ _� Balanca Dua a 20 ° • Centerline of street • Indicate Norih • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be niade 24 hrs. in advance - phone 25P•8810. 2. All work shall be performed in accordance with this permit end current City ol Everett Design and Construction Standards and Specitications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUNBER 1-800-424•5555. 7J��oa J.�2� 3�j8 Approved for Con uctio�i Dale �-/3 -�t FIPiAL INSPECTION Date Approved as Conslructed eaerett PUBI.IC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98201 Phone: 259�0810 ACKNO�VLEDGEI�fENT OF CONDITIONS W H � � O � � O a The undersiqned owner/applicant hereby a�rees to hold and save hanm less the City of Everelt from any and all claims for damages. crsts. expenses, or causes of action �hat may arise 6ecause of inslaPa�ion and maintenance of the improvemenl or other right•ol-way use nereto applied for and turther agrees to remove same upon notice !rom the Cily and lo replace puhlic properry damaged thereby. � 3 -1/- Signature ol Ap licant , J Date WORK AIITHOR!ZED BY IS PEFMIT h1UST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO BE DILIGENTLY NURSUED TO COMPLETIOtJ. THIS PERMIT M11AY BE CANCELLE-D BY THE CITY UF'ON ANY STOf'PAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.