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Date�5 29 91 � � -' � <br /> � � Pu�l¢Works Pnrmn s <br /> Application For BI4B��epl.� 91/27063 <br /> PUBLIC WORKS PERMIT PublwWorksF¢o <br /> To�a�F,e s <br /> Less Aoo�Fae PYia S <br /> BalnnteDuo $ <br /> Print or Type Only <br /> Lyle E. Blank PO Box 2266 Everett, W'� 98203 252-3326 <br /> Owner Mailing Address City Zip phone <br /> Owner <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Wofk COnStYUCt new CdTpOYt/StOYdqe <br /> W <br />�'r' Project Address�il known) 7624 Rainier Dr. � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the lo�lowing as applicable: � <br /> • Properry Lines • Centerline of street � <br /> O Outline and dimensio�is of all exis�ing and • Indica�e North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposad utililies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cafis for inspeclion shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with�his permit and current City of Everett Design and Conslruction <br /> � Standards and Specifications. <br /> 3.Call Location llnderground Ser�ice 48 hrs.belore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> 0 <br /> �U�P��C �.�cn0.�-,a�nn� �1Jcv7`�.,���vu� '.,. <br />' � S� 9-�i � <br /> 0 <br /> a <br /> ACKIJO\NLEDGEMENT OF CONDITIONS <br /> The undersic�ned ownedapplicant hereby agrees lo hold and save harm� <br /> less ihe Cip• of Everett from any and all claims lor damages, costs, <br /> ezpenses, or causea ol action thal may arise because ol installation <br /> and maintenance OI ihe irc,orovement or other righhol�way use hereto <br /> applied lor and turther agrees lo remcve same upon nolice Irom the <br /> Approved�or ConsVuc�ion Date City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date _— <br /> Approved as Construcled Signature ol Applicant Dat� <br /> Pl'BLIC WORKS DEPARTMENT WORK 11UTHORIZED BY THIS PERMIT MUST BE STARTED WITh11N <br /> ����� 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEFl IS TO <br /> ����� Everett,WA 98201 BE DILIGENTLY PUFSUED TO COMPLETION. THIS PEFA-0IT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />