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Date 11-12-93 <br />TO POSTINC <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />BLANK & EHLERS PO B( <br />Public Works Permits T L/ �] a <br />Bldg. Dept. r <br />Public Works Fee <br />Total Fee S <br />Less APPL Fee Pald $ <br />Balance Due $ <br />")-, —.35/SgS/28�/ ti/1y� fvu/ <br />IX 2266 EVERETT WA 98203 339-6794 C'� 3ZZ fo i 53/ �(i �_' /nsP <br />Mailing Address City Zip Phone <br />LYLE BLANK <br />Applicant Mailing Address City <br />Describe Proposed Wort. OFFICES AND RENTAL UNITS <br />UJ <br />Project Address (if known) 2//2f1 ��� j) —. %yf� �.. fU �� <br />.S-f <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines t Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />Proposed structures on the lot • Show any proposed grading <br />• Existing and proposed utilities <br />changes <br />• Show measurements <br />4 <br />04/19/94 11:39AM 00014N471 <br />k <br />- DO NOT WRITE BELOW THIS LINE <br />H00042671 <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All <br />BLDG '11203.00 <br />E SRCH $8.50 <br />O <br />work shall be performed in accordance with this permit and current City of Everett Desigd%M MnstrilaW5c <br />Stardards and Specifications. <br />3. Cell Location Underground Ssrvice 48 hrs. before you dig. TOLL FREE NUMBER 1.800- <br />7 ` rzzu— f <br />IaA , <br />$12.80 <br />PWINSP $80.00 <br />H00OOS062 <br />WATER $1200.00 <br />O <br />/ <br />#00029704 <br />SEWER. $70.00 <br />1171/5 <br />$1599,57 <br />CHECK $4531.39 <br />O <br />a <br />Approve Con r do Date <br />FI L SP TIO <br />Approved as Constructed <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 ''- <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />iess 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-oi-way use hereto <br />applied for and further agrees to remove same upoi notice from the <br />City and to replace public property damaged thereby. <br />S a e of Applicant Date <br />W AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />18 JAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />