4904 HARBOR LN 2016-01-01 MF Import

Date�oZ�(�Q� Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Descrbe Proposed Work _- ✓� PLI� %P h��A� r� Project Address (if known) L [ip Zip Attach lour (4) copies of plans for pr.�posed work • Draw lo scale and note the following as applicable: � Property Lines • Outline and dimensions ol all existing and proposed structures on the lot • Existino and proposed utilities r PERMIT CONDITIONS PuObc Works Permi� • ^�� BIUp. DeO�- � � Pu�ht Works Fec s Tatal Fee Less noo� Fee Paitl S Balance oue S ��— • Cenlerline of s�reet • Indicate iJorth • Show any proposed grading changes • Show measurements Phone 1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•88� 5. 2. All work shall 6e pertormed in accordance with this permit and current City of Everett Oesign and Construction Standards ana Specdicelions. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. � � a9 �� Approved fo onstruction Date ��—• i �� ,�y � __ -� -�,? •,F � Fif�AL I PECTION " Date Approved as ConstructeC everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Slreet Everett WA 98201 Phone: 259�8815 ACKN0IYLEDGEMENT OF CONDITIONS W � � � O � � O a The undersigned owner/applicant hereby agrees to hold anrl save harm- less the City of Everett trom any and all claims lor tlz,nages, costs, expenses, or causes of aclion that may arise because of installation and maintenance ol the improvement or other right-oh.vay use hereto applied for and lurther agrees to remove same upor notice Irom the City and to replace public property damaged ihereby � �� / � •// � J-� �._ i !Si�hature ol Appliaant � / ; .� � � Date N16RK AUTHORIZED 8 TMI9"�('ER IT MUST BE STAFTED WITNIN �f80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED dY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.