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1 <br />1 <br />►_� <br />Date10/28/92 <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Lyle Blank <br />Owner <br />C - �--ZQ-s <br />TO POSTING .S-_-� ��,� <br />PERMIT <br />PO Box 2266 '�verett 98203 <br />� Ma141ng Address . � <br />725 <br />PuEIIc Workf Permi� • � �� � <br />eiay. oeoi.: 38504 <br />Pu01ic WoiMs Fee s <br />TalalFee <br />Less ApO�� �ae �aid S /''}� <br />Balance0ue S �*� <br />. . City . ,.,. . Zip � '. . Phone <br />Same <br />Applicant Mailing Address City Zip � Phone <br />Deacrne Proposed Work New duplex — basic 172 <br />Project AddreSs (if known) <br />Attach lour (4) copies of plans for proposed work - Oraw to scale and note Ihe lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all ezisling and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utitities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance • phone 2S8-B$10. <br />2. All work shall be pedormed in accordance with this permit and current City of F.vzrett Design and Construction <br />Standards end Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800�424•5555. <br />C. <br />�/�/� <br />Apprcj�ed br Construction �Date <br />/� <br />o-!�� S'/o .' > 3 <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />����PUBLIC WORKS DEPARTMENT <br />3200 Ced�r Street <br />Everett, WA 98201 <br />Phone: 259�8810 <br />W <br />H <br />� <br />� <br />O <br />� <br />N <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersignzd vNnedapplicant hereby agrees to hold and save harm- <br />less the Ciry uf Everetl fwm any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because of installation <br />and maintenance ol !he improvement or other right-ot�way use herelo <br />applied lor and Iwther agreec to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />�,Li-��/" ��`5� 3 <br />ture of Applicant Dale <br />W RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED Ai�D THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WURK ON THIS <br />PROJECT OVER 90 DAYS DIIRATION. <br />