9220 EVERGREEN WAY ACTION AUTO 2018-01-01 MF Import

Date� Application For PUBLIC WORKS PERMIT Print or Type Only Mailing � J; Mailing Address Describe Proposed Work Project Address (if known) 1917 Public\YoiA.Pcrmit+ _ eiao. 000�� + Public Worke Fee Total Foo S — Less ApPI Fcc Pa�tl S_ palance Ouc $ _ Zip Fhone Gny Lip Fnone Atta�h four (4) copies of plans for proposed work - Draw to scale and note the following as • Propeiry Lines • Outline and dimensions of all nristing and �rope;ed structures on the lot • E�cisting and proposed utilities PERMIT CONDITIONS • Centerline ot street • Indicate N�rth • Show any proposed �rading changes • Show measurements 1. All calls for inspection shall be made 24 hrs. in advancz - Fhone 259•881 5. 2. All work shall be performed in accordance with this pc�mil and current City of Everett Desi�n and Construclion Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. �Ub'G�C Gvo,�.�s� �f2i»iT NJi %�r4�vi�l� Approved tor Consiruction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett. 1NA 98201 Phone: 259-887 5 `� f'`"'//97 � ACKNOWLEDGEMEIJT OF CONDITIONS W H � � O � � � a Th^ undersigned owner/applicant hereby agrees to hold and save harm� less the City of Everett from any znd all claims (or damages, costs, expenses, or causes of action that may arise because of installation and maintenance ol the improvement or other ric�ht�ot•way use nereto applied for and fwther agrees to remove same upon notice from the City and to replace public property damaged thereby. Signature of Applicant Date WORK AUTHORIZ[D BY THIS PERMIT MUST BE START[D WITHIN 180 DAYS OF DATE FERMIT IS ISSUED AND THEREAFTER IS TO BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DA1'S DURATION.