Laserfiche WebLink
4 <br />APPlicatlon for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS D FITMENT <br />TO POSTING oEe 21996°"eretl3WA Cedar1 3259-8810 <br />TYPE OR PRINT ONLY Q- <br />S <br />�t M IAA <br />MGMAB 320 108th Ave NE #406 Bell&vue Wa 98004 <br />Owner Mailing Address a '� r+ r7 •4city <br />Contact: Chris Cole <br />City <br />Date 3 45-96 _ <br />Public Works Permit A <br />Building Permit # 51109 <br />Bd <br />Public Works Fee $ ,S;y <br />462-2490 <br />Zip Phone <br />Zip Phone <br />Describe Proposed Work addition to Les Schwab Tires <br />L , <br />PROJECT ADDRESS (if known) -4959' Evergreen Way <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />- •Property Lines •Outline and dimensions of all existing and proposed structures on the let •Existing and proposed utilities <br />O . <br />'Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 2.4 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />O <br />Construction Standards and Specifications. <br />i 3. Call Location Underground Service 48 him, before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />_Z <br />C0 <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of acl'on that may arise because of Installation and maintenance of <br />the Improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damagQQilleAy. <br />Ignature'bf.ApplYcant " \ Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAYBE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />