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11/16/94 ? <br />Date <br />Y. <br />�, <br />Applicatli�n For . � <br />PUBLIC WORKS PERMII� <br />CcJ <br />T1 <br />Print or Type Only '�?���IN�j ��Z3 �� S/� <br />� <br />L'�� <br />Lyle Blank YO Bos "2266 EWerett J8203 355 47 <br />Applicant <br />Describe Proposed Work <br />Project Aadress lif known� _ <br />Mailing Ad�ress <br />Mailing Address � City <br />New dupler. - Basic 292 <br />�a�;�`���� <br />u� W u O �O 17 N <br />M? y.l P.l ('.: .M �.1 �Y. <br />ti eti di K �1 <br />OR 339-6794 <br />� <br />PubLc Works Peim.i • " <br />Bw� oeo� , C4b229 <br />Pumm worxs Fee <br />To�TI Fee s <br />�ess Appl. Fac Patl S ��•q� <br />l�� <br />a„�eppa_ s _ <br />r.,, <br />� . . <br />J /li <br />4 '� <br />.a a' <br />t •1 S. V S ��� U W p ij <br />G"�,u..�c�r�xa �n:.� <br />�iin �'�5i r�}'iou��� vi i=� <br />102G 56th St S� (Ai-(3� Lot 2 S.P. 21-94 <br />, Attach four (4) copies o( plans for proposed work - Draw to scale and nole ihe following as applicable: <br />. • Property Lines • Centerline ol street <br />� • Outline acd dimensions ol all existing and � • Indicate Norih <br />proposed s�iuctures on the lot • Show any proposed grading chanyr,s <br />,.�-Existing and Croposed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2. All work shall be performed in acwrdance with this permit and ru:rent Ci;y 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 />i. iiooftol; clrtin:,�e :;h�ll be �ai,cii�:rge;f: <br />• i�il iili3 aI�4�S d�OTlri i�Calll S�':tCIil (j�;1:8�C Ui public� <br />• �TU �; Cr•81�i811�1� lOOi J01"vi���i011� .ii%>iclll i�C� i�;ltcCl }irI ::ccli00 �i- <br />:, � �,� �n� ::,�v �<<u�a,ua:: , <br />s, +:�nt�� sp'ash blocks <br />i he m.,�h�ui celecte�l wiil be sitb�r��t tn F'tiblic �Jv�nrl;< i�epartement <br />t�pprov.�l. <br />�, '� :r(;?� t � � n� � v�� G� v.� ( <br />p✓GI��"✓ �Pi1�V �e-�'. <br />y��, <br />�.t,�if%l�YE� �Z�/�9� <br />Approvedfor ConsVuction �—� Date <br />i� <br />�`_,� =- -- ---�' -- �, . _ y r- <br />FINAL I��SPECTION Date <br />Approved as Consirur.ted <br />PUBLIC WORKS DEPARTMENT <br />3200 CedarStreet <br />a, Everett. WA 98201 <br />Phone:259-8810 <br />�rr,d-s�r� r�4�c��� �� I v2 or, <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersiqned owner/applicant hereUy agrees to hold and save harm- <br />less ihe City of Everet� from any and ail ctaims for damages, cosis. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other righl-ohway use hereto <br />applied for :.nd luriher agrees to remove same upon notice Irom tne <br />Ciry and to replace public property damageA thereby. <br />/ i' <br />''' � �� � ���s <br />�fU , ; �lil-� � <br />� Signatu e ol Applicant Date <br />WOFiK AUTHORIZED BY THIS PERMIT MUST RE STAR?ED WITHIN <br />1i30 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 UN THIS <br />Pf70JECT OVER 90 DAYS DURATION. <br />