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Date 1��16/94 <br />AppliCation For <br />PUBLIC WORKS PERII���� ,a�SJ� <br />Print or Type Only <br />'-Lyle Blank PO Box 2266 Eve <br />Owner Mailing Adtlres; <br />Applicant Mailing Address <br />Describe Proposed Work <br />Projecl Address (if known) � � <br />' c� c:i �c� r, c, �, <br />c'i o r, c� n, r.i <br />v� r, r� c.� • ci <br />, , p� ' . ;n � _ ,., .. <br />.,�.,..r,... --- �- <br />Publrc Works Permu � �I �G�7_� <br />Bi4g.0eD��+ 4�4q7 <br />PubLc Works Fee <br />TolalFea $ <br />LP55 Appl. FCC PdiE �S <br />�_� -�4�3^fe,Dw S <br />r-+ r . In n <br />r. ;:,. �.,, ., <br />� .. , .- <br />.,��y .,-, �;{ r%. 4r1 <br />r7 r.0 �_ r� '. �::j tCi <br />(` (1 (_1 /.l Ll '':.1 f.J -'1 <br />._I liJ . .: -. , <br />) O. Y.�. � lq f"� C, ':Y <br />t-'ry <br />Y'l 1 � <br />�.%� <br />c'p Phone <br />Atlach four (4) copies ol plans lor proposetl work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lot <br />• Existing anc� proposed ulilities <br />"L' <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- �hone 259•8810. <br />2. All work shall be pedormed in acwrdance wilh ihis permit and current City of Everett Design and Construcfion <br />Standards and Specifications. <br />3. all Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEA 1-$00-424•5555. <br />Rooltop dr�ina�c, toundation drains �nd crazvl space drains shail be ti�l�tlured to thc public drainagc <br />culveit in die street lmay reqi�ire u�stallation of a new catch basia). Consuli with Qie Public Works <br />uispector p�iur lo connectiou - plione 339-7�10•1. <br />S The rr.sidence buih on this lot i; �cquired to inst�ll a lire cprinkler svsteri meetin�� NI�PA 13D. <br />3 <br />Approved as Constructed <br />��PUBLIC WORKS DFPARTMENT <br />3?00 Cedar Street <br />Everetl, WA g8201 <br />Phone:259-8810 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />•J <br />The undersigned owner/applicant hereby agrees to hold and save h�rnr <br />less Ihe City of Everett Iwm any and all claims for damages, cosls. <br />expenses, or causes ol action that may arise because of installafion <br />and maintenance of ihe improvement or other righ�-of-way use hereto <br />applied for and further agrees to remove same upon notice from th? <br />City and to replace public property damaged thereby. <br />� ;� --S/�/ys <br />� na re of AppliCant Date <br />W AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1 DAYS OF DATE PERMIT iS ISSUED AND THEREAFTER IS 70 <br />8E DILIGENTLI' PURSUED TO COMPLETION. THIS PERAIIT MAY BE <br />CANCELLED Bl' THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />