5121 HARBOR LN 2016-01-01 MF Import

Cate1S J I � 00 Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address Malling AtlOre55 Puobc worxs Par t r `" �—�� / BIdB Dept. • — Publi:WorksFee s Tolxl Fea Less 4p0�. Fee Pa1d s � Oala� ce Due S �Q O up rnone Describr. Proposed Work _LL.�A � C�rc..--� � `J i—�y—'�`� �� Proiect Address (if known) ��2 � G .</. Atlach four (4) copies ol plans lor proposed work � Draw to scale and note Ihe following as applic.�ble: • Property Lines • Outtine and dimensions ol ali existing and proposed structures on the lot • Existing and ,�roposed utilities Approved lor • Centerline of sireet • Indicate North • Show any proposed grading changes � Show measurements PERMIT CONDITIONS 1. All cells for inspectlon shull be made 24 hrs. in advance • phone 259•8810. 2. All work shall be performed in accordance with this permit and current Ciry of Everett Design und Construction Standards and Specificalions. 3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800�424•5555. 7 Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Sireel Everett, WA 98201 Phone�.259-8810 ACKNOWLEDGEMENT OF CONDITIONS W H � � � O � � O a The undersigned owner/appliCanl herety agrees to hold and save harm- less the Ciry of Everett from any and all claims for damages, costs, expenses. or causes of action that ma�� arise because of insta�lation and m ntenance of the improvement or other right-ol•way use hereto ap ed 1 r and lurther agrees to remove same upon nolice irom the C' v and rePlace public property damaged thereby. / ^ Date -- S ure of Applicant Dale WORK AUTHORIZED F1Y THIS ERMIT MUST BE TARTED WITHIN 180 DAYS nF DATF PERMIT S ISSUED AND THEREAFTER IS TO BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORI<ON THIS PROJECT OVER 90 DAYS DURATION.