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L <br />Date_ <br />Application I ... <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mark Wilson <br />1522 73rd Street Everett <br />Public Works Permit a <br />Bldg Deol. a R I f 119 Q Q <br />Public Works Fee : <br />Total Fee <br />Less Appl. Fee Paid $ <br />Balance Due $ <br />353-3264 <br />Owner Meiling Address City Zip Phone <br />PermaBilt Industries Inc. 3416 Everett Avenue Everett 98201 252-5575 <br />Applicant Meiling Address City Zip Phone <br />Describe Proposed Work <br />Project Address (if known) <br />Use Existing Driveway <br />et <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimenalons of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for Inspection shell be made 24 hrs. in advance - phone 259.881 5. <br />2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NU BER 1.800.424.5555. <br />P�M')r <br />r <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />treet <br />Ever Ceder 8201 <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />U) <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCEL I_ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. i <br />