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TYPE OR PRINT ONLY <br />Royal <br />Owner <br />0 & ze25 <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TO POSTING SEP 24 1996 <br />Homes 13725 <br />Address <br />Date 1-24-96 —7 <br />Public Works Permit N�� ` <br />Building Permit p 50675 <br />Public Works Fee S zoo_ o <br />Ave Snohomish 98290 568-2071 Paul <br />City <br />Owner Phone <br />Applicant <br />Mailing Address City Zip <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines "outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />-Centerline of street -Indicate North 'Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4 A5 ��I p/ b(r6 \vorAs )�ctecj' plo;h dPted 31fcll � <br />S <br />V♦ <br />O <br />a <br />03/22/96 1:41RM OOOP !% <br />/ <br />400050674 <br />206 $556.33 <br />PLED $84.00 <br />MECH $60.00 <br />SRCHRG $4.50 <br />DRIVWV ?20.00 <br />900030576 <br />SEWER $70.90 <br />SVSDE'J 91296.00 <br />.vlp_ purr•{� .C�02QN on <br />ACKNOW LEDGEFiIENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />e the City of Everett from any and all claims for damages, costs, expenses, or <br />/� �— causes of action that may arise because of installation and maintenance of <br />FA—pstruction Date the improvement or other rigtt-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public properly <br />ed thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed - <br />Sig ature of licant v Date <br />CWORK AUTHORZED BY THIS PERMIT MUSTOMPLETION. TIHIS PERMIT MAY BE CANCELBLED BY THE CITY (UPON ANY STOPPAGE OF WORK ON TDIS PROJECT OVER 90 CAYSEDURATION. <br />PURSUED TO <br />