4805 EVERGREEN WAY LES SCHWAB TIRES 2018-01-02 MF Import

Date_,�r/ Application For PUBLIC WORKS PERMIT Print or Type Only zip Applicant Describe Proposed Work Project Address (if known) Attach four (4) copies of plans lot proposed work - Draw to scald and note the following as aliplicable Public Weds Permit S Bldg. Dept. s Public Mike Fee $ Total Fee Less Appt Fee Paid $ Balance Due • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show meae.urements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hr& in advance - phone 259.881 5. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. IAIE7 �F2m.i Alv7- lf'�CPCUr eE,12 Approved for Construction Date FINAL INSPECTION Approved as Constructed J ev�/ PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everitt, WA 98201 Phone. 259-8815 /z_ V- F,4 lf_�z ACKNOWLEDGEMENT OF CONDITIONS W ttttttttt� O z 0 0 a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvoment or other right-of-way use hereto applied for and further agrees tc remove same upon notice from the City and to replace public property damaged thereby. Date Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND 1HEREAFTER IS TO 3E DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE CANCELLED BY THE CITY UPGN ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.