2317 MCDOUGALL AVE 2016-01-01 MF Import

Date�Q�� Application For PUBLIC WORKS PERMIT Print or Type Only Address Pu�lic Woeks Permit • u�� '�� `— emq oeo�� • � PWIicWorASFea S Total Fee — Le55Appl. Fee Pa�U s BaianceDuo S 2n� Zip Phone �/'i /M �/ L-C�1N, qpplicaM Mading Address Cdy Lp Phone Describe Proposed Work Prolact Address 1i1 known) � Attach four (4) copies ot plans for proposed work - Draw to scale and • Property Lines • Outline and dimrnsions of all exisling and proposed structures on the lot • Existing and proposed utilities Ihe follo�ving as applicable: • Centerline of street • Indicate Norih • Show any proposed gradinp changes • ShoH measurements PERMIT CONDITIONS 1. All calls tor inspection shall be made 24 hrs. in advance - phone 259•881 O. 2, All work shell be peAormed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Unde�ground Service 48 lirs. belore you dig. TOLL FREE NUMBER 1•500-424•5555. � ��.�� �� � � ,� � �,►� � � '�>,1�/1� �70�> f�� L/i 6'B Approved lor Construction � Date FINAL INSPECTION Approved as Constructed everetl PUBLIC WORKS DEPARTMENT � 3200CederStreet Everett, WA 90201 Phone:259-8810 Date ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � 0 a The undersi9ne.d ownedapplicant hereby agrees to hold and save harm� less ihe City of Everett from any and all claims lor tlamages, costs, ezpenses, or causes ol adion that may arise because ol installation and main�enance ol ihe improvement or other righl-ol-way use heieto applied for and lurther a9reos lo remove same upon notice irom the Cit� and t�enlace publi� prop�rty�d7maged Ihereby. � Signature ol Applican� � ' Date WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTE� IS TO BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT 61AY BE CANCELL[D BY 1�HE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIOM.