4931 HARBOR LN 2018-01-02 MF Import

Date lLi8�) Application For PUBLIC WORKS PERMIT Print or Type Only Owner Mailing Addr ss Describe Proposed Work _1 r J k \I ` -- v,9_ -- LDT 3 Project Address (if known) Publlc Work: Per 1---L+�Y—�-'— l 71da DePL< PAhc We ks Fee Total Fec Less APPl Fee Paid $ —. pn Balance No $ — - llll � Zip Phone Attach four (4) copies of plans for ,ioposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed glading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for ins,)ection shall be made 24 hrs. in advance - phone 259-881 5. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. %- for FINAL INSPECTION / Date Approved as Construred i PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS z 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 maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove samn upon notice from the City and to rep' • public property damaged thereby. y� Signature Applicant Date WORK A THORIZED BY THIS PERMIT MUSE 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 THIS PROJECT OVER 90 DAYS DURATION.