5711 HIGHWAY PL 2018-01-02 MF Import

DBtee—%� TO POSTING e.e. D.O . — Application For PUBLIC WORKS PERMIT •— L....od F. n.0 II D.. •--A Print or TYDe Only ¢die y (c,y g210 GV0z6TaEA) VJAy Applicant Mailing Address .;ny 7.Ip Phone Describe Proposed Work J,t�J�€t1lFaT� Project Address (if known) Attach tour (4) copies of plans for proposed work - Draw to scale and no!e .he following as applicable. • .'roperty Lines • Centerline of street • Outline and dimensions of all existing and 4 Indicate North proposed structures on the lot I Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 his. in advance - phone 25"810. 2. All work shall be Performed in accordance with this Permit and current City of Everett Design and Construction Stande•ds and Specifications 3. Call Location Underground Service 48 him before you dig. TOLL FREE NUMBER 1.800-424.5555. y �o- �i��,>/ le-�J-sT "� Date FINAL INSPECTION Approved as Constructed IBM I=A 3200C WORKS DEPARTMENT 3200 Cedar Street Everett. WA 98201 Phone'259-8810 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. or causes of action that may arise because of installation and maintenance of the improvement oother righeol•way use hereto applied for and further agrees to remove same upon notice from the City and to replag$lagblic propertyoamaged thereby. Signalur�nl Dale WORK Al' iORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYb OF DATE PERMIT 15 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 OVER 90 DAYS DURATION.