20 SW EVERETT MALL WAY AUTOMOTIVE GLASS REPAIR 2016-01-01 MF Import

�� .. - ir!s. .. ( , App�ication For PIUBL�C WORlCS PERMIT Print or Type Only a�er� wo�xa P u . eiea� 000�.+� � Public Works Fee Total Fee � less AppL Fee PaiO '3 Balance Oue S�!/�j Applicant A4alling Adtlress City Zip Phone Describe P.oposed Work Prolect Add�ess (if known) Attach four (4) copies of plans for proposed work • Draw to scale and nole Ihe followir.g as • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities • Centerline of street • Intlicate Norih • Show any proposed grading changes • Show measuremen�s PERMITCONDITIONS 1. All calls for Inspection shall be made 24 hrs. in advance • phone 259•8810. 2. All work shall be periormed in accordance with ihis permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underc�round Service 4B hrs. Eefore you dig. TOLL FREE NUMBER 1•800•424-5555. r�?� �c�l ��r� Approved for Construction � Date FINAL INSPECTION Date Approved as Constructed everett PUBI.IC WOpKS DEPART�AENT � 3200 Cedar Sireet Everetl, WA 98201 Phone: 259•8010 ACKNOWLEDGEMENT OF CONDITIONS �� � � �O The undersigned owner/applicant hereUy agrees to hold and save harm- �ess the City of Everelt Irom any and all claims fo� damages, costs, expenses, or causes of aclion that may arise because of insfallation and main�en2nce of the improvement or o�her right�oFway use hereto app�ied for and lurther agrees to remove same upon nolice Irom ihe City and ro raplace public property damaged thereby. Signature of Applicant Date WORK AUTHOHiZED BY THIS PERMIT MUST BE STARTED WITHIN i 180 DAYS OF D,4TE PERMII' IS ISSUED AND THEREAFTER IS TO BE DIL�GFNTLY PURSUED TO COMPLETION. THIS PERIAIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIOIJ. �