10730 19TH AVE SE BODY FIRM 2016-01-01 MF Import

��/��,C r'.�'� r�.I Date�.2��D J Pu01ic Works Permi�• Application For eiee�o�Pi.. PUBLIC WORKS PERMIT PobbcWorksFee -- Tolal Fee Less ADpI.Fee Pa�. �___, Print or Type Only ea��<e o�e s iq�'' L��h�r�a�`�� Owner Mailing Address City Zip Phone Applicant Mailing Addr2ss City 2ip Phone � Describe Proposed Work �- •� , � �a_ �I�� J � W Project Address(if known) - � �� Attach four(4)coDies of plans for proposed work- Draw to scale and note the following as applicable: �� � • Property Lines • Cente�line of street � • Outline and dimensions ot all existing and • Indicate North � proposed structures on the�ot • Show any proposed grading changes . • Existing and proposed utilities • Shov+measurements � DO NOT WRITE BELOW THIS LINE PEFMIT COIJDITIONS O 1.All calls lor inspect(on shall be made 24 hrs.in advance-phone 259•8810. � 2.All work shall be performed in acwrdance with this permit and current City of Everett Design and Construction � . Standards and Specificaliona .. 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00•424-5555. � ' /`�w �'�� /�.� ,� O / � - c�� F` 92�- aa N O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees lo hold and save harm- less the City of Everett from any and all claims tor damages, costs, expe�ses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of•way use hereto applied tor and further agrees to remove same upon notice from the Approved for Construction Date City and to replace public property damagetl ihereby. FINAL INSPECTION Date Approved as Constructed Signature of Applicant Date everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEN IS TO Everett,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE Phone:259•8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.