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Application For �Q P 0 STI N G � 1 s � / <br /> � PUBLIC WQRKS PERMIT D81e 2-z1-96 _ <br /> PUBLIC�KS DEPARTMENT Public WorNs Permit q _G�Iv�Q_� <br /> 92 edar Stiaet <br /> Everett,WA�8201 259-8810 <br /> f� euilding Permit#_50921 <br /> �i c o r.- r � r:, �, r ... <br /> TVPE OR PRINT ONLY S. ' � � r� ' �� c.�i: �,r�� <br /> ` r u �. � i,-, c � �.Aiblic Works Fee$ K.J <br /> li�� �,. ;t. - +:i en C. <br /> r.. Y,i �� ,.. <br /> Borseth Custom Homes Inc 124Y State Ave M�$'ysS�lle"WA 98270 653-3720 <br /> Owner MailingAddresya ., �:; r ;� Ci � �' Zip Phone � //^'\� <br /> � o> > -�s � n e- r-� i � �, <br /> a C� 4� ( � > CJ �I G I � O <br /> C 1 f' f:� u l t :.. i C Gf �� �� [ l i �� <br /> Contact: Kirk Borse[h or aarF,Rp 1�A4y� ;� .�.. � .,. „ „ ,�-: <br /> Applicant Maiiing�� Ciry Zip Phone <br /> Describe Proposed Work new house <br /> W <br /> H <br /> - <br /> � <br /> PROJECT ADDRESS(if known) _ 15 Alder St Lot 10 Parkside East <br /> Attac�tour(4)copies of plans for pmpased work-Oraw to scale and note the tollowing N apnlicable: � <br /> 'Property Lines 'Outline and dimensions of all exisfing and proposed structures on L�� 'ut •Existing antl proposed utilities <br /> 'Centarline of street ryndicate North 5how any proposed grading changes •Show measuremenGs � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: �J <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. �� <br /> 2.All work shall be performed in accordance with this permit and current City af Everett Design and O <br /> CorstruMion Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> 4. Kaep cily ottasts clean at alt timea. � <br /> 5. Cueb gutter end ddewalk in the plat are new end undamt�gnd, anp damege theret � <br /> s6a11 be replaced at the discreNon of the Public �fiorks Iny►actur. <br /> 6. Any change in the driveway cut must !+e epproved by the Public Worka tnepector <br /> width At prop liae limlted to esi�ting apron �dth <br /> 7. Adjust weter boaes to g�ade et end of conatruction. <br /> 8. DrivewAys�Il be complately oured before driviag on thouu� <br /> 9. RooRop drsineQe�hell be discherged to the lots infiltreYlon trench s�a per the city's <br /> "Re�ideatial Roof Downrpout 8qstem" flet6�I dltd qf[!@i YI18 IOC9��OI1 �f32SR1ilNOp Op <br /> the loYs dte plaa. My c6en�e fn tha InflltratLon trench mu� be approved bp t�f <br /> Publlc Works In�peotor. Call for inspection prior ko �overing. <br /> l�� 0/e q-:vu� rn�s� x �4�C�o%rtedc.�ifZi hlw �// h4qait C•�rb�.N�- <br /> t s;deua/k �' sf/+�3AG. Altw� Q-1 �7 p�r �ld�3o7. <br /> "1�� C��/ 3 39-7403 b,G,�e� r <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � � � The undersigned owner/applicant hereby agrees to ho1G and save harmless <br /> the City of Everett from any and all claims ta damages,costs,expenses,or <br /> Approvetl tor Co ction DaY causes oi sction that may arise because ef installation and meinfenance of <br /> the improvement or Mher right-of-way use heretc applied for and further agreas <br /> """��, to remove same unon notice from the City and to replace public property <br /> � � p_� S/_ q� damagetl ereby. <br /> INSPECTI �Date / / <br /> Approved as Constructed /� /5� S �Q_ y/- <br /> L �i 1i <br /> Signature of Applicant Date <br /> WOHK AUTHORIZED BY THIS PERMIT MUST BE STARTFD WITHIN 180 DAYS OP DATE PERMIT IS ISSUED AND T3IEREAFfFfl IS TO BE DIUGENTLY PURSUED TO <br /> COMPLETION.TH�S PERMR MAV BE CANGELLED BY THE CIN UPON ANY STOPPAOE OF WORK ON THIS PROJE6T OVER 90 L1qYS DURATION. <br />