3215 21ST ST 2018-01-02 MF Import

M Application For t PUBLIC WORKS PERMIT °Eta o T jp,7 PUBLIC WORKS DEPARTMENT Public Works Permit R _Z71'!!� 3200 Cedar Street Everett, WA 98201 259-8810 _ G�" Building Permit 0 rena;-,BBC 0 'o0 TYPE OR PRINT ONLY Public Works Fee $ �_ — �li9�r�Sr% NRu1x� `iL15-Lsr Eti�� f Styr'+ _-� 3FP y9co Owner Meiling Address City Zip Phone N/-? L/! GANfT: zr ; L HrlY,ir,o Arm C41:v/7- y n-or Zrt--9 ysC7 Applicant Mailing Address City Zip Phone t, Describe Propnsed Work. Cod =r�`� � t �Y+�H F "'� �' cc' /l[Gyr o/ l�if Uj ♦♦wAA V♦ PROJECT ADDRESS (if known) Attach four (4) copies of plans for proposed work - Dr:w to scale and note the following if applicable: im "Property Lines •Outline and dimensions of all oxisting and proposed structures on the lot 'Existing and proposed utilities •Centerline cf street •Indicate North 'Show any proposed grading changes •Show measurements 00) UV IYV I �1'1111L YLVy �• ., nv r.. PERMIT CONDITIONS: 97 3:30FM OCORNll Z3 OS�D7� 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. 7139 O 2. All work shall be performed in accordance with this permit and current City of Eve�ret6essign and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM SM-4 W5051_. O a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless the City of Everett fwm any and all claims for damages, costs, e:.:. renses, or causes of action that may arise because of installation and maintenance of the improvement or other dghtof-way use hereto applied for and further agrees to remove same upon notice from the City and to rep!ace public property damaged thereby. Signature of Applicant Date WORK AUTF'ORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.