503 ROSE WAY 2016-01-01 MF Import

Date�� �� ApPlication For PUBLIC WORKS PERMIT Print or Type Only Applicant Mailiny Putil¢ Wo�4s Pcrmil • oiaa oan�.• ��,�,�Wo,,,F�o s rotnl roc less F001 foc PxW S Oalanr.i p��. $ Phone Describe Pwposed Work `��„�� I�L� �� Prolect Address 1i1 known) Atlach four 14) coples of pians for pioposed work • Properry Lines • OWline and dimensions ol ell ea�sting and proposed struCtures on Ihe lot • Ezisling and proposed utilities to scale antl note ihe lollowing as applicable: • Centerline ol street • Indicate North • Show any proposed �rading changes � Sho�•� measuremenls LI PERM�T CONDITIONS 5. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All work shall be pedormed in accordance with this permit and current Ciry ol Everetl Design and Construction Slandards and Specifications. 3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800•�324•5555. Approved for Con�truclion FINAL INSPECTIUN Approved as Construcled everett PUOLIC WORKS DEPARTMENT � 3200 Cedar Slreet Everett, WA 98201 Phone�.259-8810 �CKNOWLEDGEMENT OF CONDITIONS W H � � O � � O a The unJersigned owner/applicant hereby agrees to hold and save harm- less the Cily ol Everett irom any and a�' claims lor damages, costs, expenses, or causes ul acliun that may arise because ol installation and maintenance ol lhe improvement or other right-obway use hereto applied for and further agrees to remove same upon notice Irom the Dale City and to replace public properry damaged thereby. Signature ol Ap�licant Date WORK AUTI10f;ILC-D BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 8[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THC CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 OAVS DURATION.