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Application For p V� � � <br /> � PUBLIC WORKS pERMIT Date 2/20/96 _ <br /> PUBLIC WORKS DEPARTMENT Public Works Permit M <br /> 3200 Cedar Sireet <br /> Everett,WA 98201 259-8810 Building Permit A �no <br /> TYPEORPRINTONLY TO POSTING �"-a"� PublicWorksFee$ ��� <br /> A1 Jubie 1821 19th Dr Mukilteo 98275 290-1456 <br /> Ownbr Mailing Address City 2ip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work_ New house — Basic 1115 <br /> psin� ,.. _ __.,,,R.,._ �t <br /> . <br /> _� _ �A <br /> ��� <br /> V� <br /> PRWECTADf'Q'_SS(if knowni �Z�,1 �Y�'!,$ AV(i �""" _� <br /> Attach four(4)coqes of plans for proposetl work-Draw to scale and note the following if applicable: c c: � � <br /> �Property Lines 'Outline and dimensions of all existing and proposed structmes on the lot •Existing and proposetl utilitie3'�^ ^!! O <br /> �Centerline ot street •Indicate North 5how any proposed grading changes 5how measurements - � -^ °'� G� <br /> .. � ,•.r. m ' <br /> DO NOT WRITE BELOW THIS LINE --.��R <br /> PERMiTCONDITIONS: - t.,�.- rn � <br /> 1.All calls for inspectiom shall be made 24 hours in advance-phone 259-8810. • ---��.a <br /> 2.All work shall be performed in accordance with this permit and current City of Everott Desiprtane) O <br /> ConsVuction Standards and Specifications. -. - - , „,�� � <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-42{-5655. � <br /> 4. RooBop drainage shal) be discharged: Q <br /> a) To the site's storm drain aystem(private or pubiic) <br /> b) To a resideatial roof downe�pout system designed per section 4-9.4 of the a <br /> cily standards <br /> c) Qnto eplash blocks <br /> The method aelected will be subiect to Public Worke Denarte^nent aporoval. <br /> 5. Driveway must bz paved from properiy liae to z�lge of etreet pa�•�mert. <br /> 6. Replace sidesewer to property line and install new as per standard plan#b01. <br /> I <br /> o��Y <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> j The untlersigned owner/applicant hereby agrees to hold and save harmlexa <br /> �_ �7 the City of Everett Irom any and all claims for damages,costs,expansas,�r <br /> Ap etl fo Con�t cf Dat causes ot adion that may arise because of installation and meintenance of <br /> � / theimprovementorotherright-of-wayuseheretoapplietlforandturtheragrees i <br /> G / 3 S �� to remove same u�on notice trom the Ctty and to replace public property <br /> d tlamaged thereby. <br /> F INSPECTION Date r li <br /> Appoved as Constructed <br /> p-. I <br /> , SignaNre� Applicant e I <br /> WORK AUTHORIZED BY THIS PERMR MUST BE STARTED WITHIN 180 DAVS OF DATE PERMR S ISSUED AND 7HE FfER IS TO BE DILIGENTLV PURSUED TO � <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANV STOPPAGE Of W RK ON THIS PROJE T OVER 90 DAVS WRATION. <br /> i <br />