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Date. 4-27-94 <br />A1np6cation For << ')STING lift - <br />PUBLIC WORKSOERMIT <br />OO <br />O <br />Print or Type OnlyIc <br />6t 171I'?OO It Cl 00 CD <br />1 Mtk M M b rl1 <br />M O M <br />Lyle Blank PO Box 2266 Everet!jZWWAri98203-3--555-4r25 <br />Ownel Ma ;in,,; d ACdrKSS .(CC��,71>:�C.j v y <br />[V O �di U10 U] �031- W <br />Owner <br />Fain`li8imo11'M <br />Applicant M;dlnp Address City <br />Describe Proposed Work _ new house <br />Lot 2 Sho:t Plat 40-93 <br />Project Address tll known) <br />Puol¢ WorkS Palrrd.n ngp�o�4/ I Jw / <br />Bldg Dept. S--4422. <br />Public WorkS Fee 5 <br />Total Fee <br />Lest Apot Fee Paid 5 <br />Palance Due s r^� <br />Zip Phone <br />Attach four (4) copies of plans lot proposed worK - Draw to scale and note tho following as applicable: <br />• Property Lines • Conterline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lot inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be Performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />© ,L <br />ANpro r Cons r .tion \\ Dale— <br />N I SPEC J f Date <br />Approved as Constructed <br />Q4ffPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />W <br />M <br />O <br />n <br />z <br />O <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ilia City of Everett from any and all claims lot damages. costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-obway use hereto <br />applied for and further agrees to remove same upon notice from the <br />C+ty_a4 to replace public property damaged thereby. <br />i we of A pllcant Date <br />RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />80 DAYS 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 />