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� y <br />C�H <br />�O�y <br />�p <br />'il y �+tl <br />�H� <br />�€�g <br />�r n <br />ry�N <br />h�a�y <br />bd y�+ <br />�OC�i+ <br />'_i <br />� <br />Date 10/28/92 <br />c�'—r —�0 2�-5 <br />Applicallon For <br />PUBLIC WORKS�����T s,�. - 3 <br />Print or Type Only <br />Pu�lic Wo�na Fu�unl • � � / <br />eme� oeai.. 38505 _ <br />Puelic WOMs Fce <br />total Fe r S <br />�ess noo� Fee aam S <br />Belance �ue $ �- <br />Lyle Blank PO Box 2266 Everett 98203. 355-4725 <br />Uwner ' Mai4ing Address � - Ciry �, Zip Phone <br />Same — <br />Applicant Mailing Address Ciry 2ip Phone <br />New duplex — basic 172 <br />Describe Proposed Work <br />Project Address (if known) 57� <br />Fleming � 5T Lot s i4 C Z— 33 — <br />Attach four (4) copies of plans for propnsed work - Draw to sccle and note the tollowing as applicable: <br />• Property Lines • Centerline ol street <br />• Outline and dimensions ol all existing and • Indicate Nortli <br />proposed siructures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shell bo performed in accordance with this permit and curreni City of Everett Design and Construction <br />Stendards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•4245555. <br />for <br />�proved as Consiructetl <br />PUBLIC WORKS DEPARTIv1tNT <br />3200 Ceder Slreet <br />Evarell, WA 98201 <br />Phone: 259-BB10 <br />/- /Z/�z <br />Date <br />Oate <br />� <br />O <br />� <br />N <br />O <br />a <br />ACKNONlLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City oF Everett Irom any and all claims lor damages, costs. <br />expenses, or causes of action that may arise hecause ol installation <br />and mair.tenance ol ihe improvement or other right-ohway use hereto <br />applied for and furiher agrees to remove same upon notice Irom the <br />Ciry and lo replace public property damaped ihereby. <br />,� � .K�� %/ys <br />ig lure ol ApPlicant Date <br />RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />7B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />