1308 MCDOUGALL AVE 2016-01-01 MF Import

Dete �� Applicalion For PUBLIC WORKS PERMIT Print or Type Only � «:� rz /l�dfK_ s�d.� ; 3 ob' ; Owner Maihn� Address �Ab1N- Applicant Mailing Acdress Describe Proposed Work _ ` •—�^-4 - - h` `�C'��tJ� " —"'"--`��'�` a ��—� Proiect Address (if known) �� Altach four (4) copies oi plar.s for proposed work - Uraw w scale dnd note the following as applicable: • Prcperty �inas • Outline and dimensions nt all existiny and proposed structures on �he lot • Existing and proposed utilities PubLc WarFs Permit Y G� aiae o�P� . �S'.3 �3 .�/ Publlc Works Fee $ TOlal Fee L¢ss AO�I. Fee Paltl � Balence Uue � �.�`oZ - �i � 9 / Phone Pl�one • Centerline ot street • Indicate North • Show any proposed gradina changes • Show measuremenis PERMIT CONDITIONS t. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. belore yo� dig. TOLL FREE NUMBER 1•800•424-5555. �b / er � / �-(, �� _�� Approved for Construction Date FINAL INSPECTION Dale Approved as Constructed everetl PUBLIC WORKS DEPARTMENT � 3200 Cedar Streel Everett. WA 98201 Phone:259-8815 ACKNOWLEDGEMENT OF CONDITIONS � O The undersigned owner/applicant hereby agrees lo hold and save harm- less lhe City of Everelt (rom any and all claims for dam�ges, cests, expenses, or causes ot action Ihat may arise because ot mstallatwn and mainlenance of the improvement or other righbof-way use herPto applied for and turther agrees to remove same upon notice !rom the City and to replace public property damaged thereby. Signature ot Applicant Daie WORK AUTHORIZED BY THIS PERMIT M11ST BE STARTED WITHIN 180 DAYS OF DAT� PERMIT IS ISSIIED AND THEFcAFTER IS TO BE DILIGC-NTLY "URSUED TO COMPLETION. THIS PEFMIT MAY BE CANCELLED �Y 1 HE CITY UPON �NY STOPPAGE OF WORK ON TH:S PROJECT OVER 90 DAYS DURATION.