6008 MCDOUGALL AVE 2016-01-01 MF Import

Date '/Q" Application For �UBLIC WORKS PERMIT Print or Type Only STEVE i3�G[3EF Owner Pu01m Wo�hs Permlt � ___ eieo. oeo�. • __ Public Worka Fee 5 To1al Foe Leas Appl Fee PeiE S Balenca �ue s �a�3 ,3s3-7oo Phone 5.9-m E Applicanl Mailing Address City Zip Phone Describe Proposed Work Project Address (if known) /'�LF f Attach tour (4) copies ot plans for proposed work - Drew to scale and note the tollowing as applicable: • Proper;y Lines • Outline a�d dimensions of all existing and proposed structures on the lot • Ezisting and proposed utilities • Centerline of :treet • Ind�cate North • Show any proposed grading changes • Show measurements PERMIT CONDiT10NS 1. All calls !or inspection shall be made 24 hrs. in advance • phone 259•881 O. 2. All wurk shall be performed in accordance with this permii and current City of Everett Design antl Construction Standards and Specificalions. 3. Call Loa�tion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•555:i. lor Conslruction FINAL INSPECTION Approved as Conetructed �A��PUBLIC WORKS DEPARTMENT 3200 Cr,darSVeel Everett, WA 98201 Phone:259�8810 � ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � 0 a The undersigned owner/applicant hereby a9rees to hold and save harm� less Ihe Ci�y ol Everetl trom any and all claims for damages, costs, expenses, or causes ol action that may arise because of installation and maintenance ol the improvemenl or olher right-ol-way use herelo applied for and further agrees �o remove same upon notice from the Date City and to replace public property damaged thereby. Date Sic�natwe ol Applicard Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. TFIIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURATION.