4321 RUCKER AVE CARLSON AUTOBODY 2018-01-02 MF Import

Date Za" A2 - 60 Application For PUBLIC WORKS PERMIT Print or Type Only An Work Project Address (if' known) � �reke Ate-- Pubbc Works Permit • Q Bldg Dept. a . 10 �J Pubt c works Fee Tolai Fee f - Less ADpl. Fee Paid S Balance Due S City zip D -/' -P4 /.t/ rrQe Li Gu 9 proposed stru Attach four (4) copies of plans for proposed work - Draw to scale and note the tollowl as applicable: • Centerline street • Outline and dimensions o1 all existin and • Indicate No ctures on the lot • Show any prop sed grading changes • Existing and proposed utilities • Show measurem is DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. 2. All work shall be performed in accordance with this permit and current City of Everett Cesi and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-8010.4 •5555. • Property Lines o Approved for Construction FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT Ever tt. WA Street Everett. WA 98207 Phone: 259-8815 Dare ook p, �Ul b�- W H 0 z 0 0 a ACKNOWLEDGEMENT ITIONS The undersigned owner/applicant hereby grees to hold and save harm- less the City of Everett from any and all claims for damages costs, expenses, ocauses of action that may arise because of installatior and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Dale Signature of Applicant 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. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.