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�� <br />TYPE OR PRINT ONLY <br />F�' POSTING �uk_._ 2= <br />App�iwlion Fdr ��—��—�� <br />PUBLIC WORKS pERMIT Datn <br />PUBLIC WORKS DEPARTn1ENT Public Works Permit�� ��� <br />3200 Cedar Slreel <br />Everett, WA 98201 259-8010 Building Permit q_ 53848 _ <br />Zo� <br />Pablic Works Fee $ __ ����y� — <br />Neslen Welch 6322 76th Dr SE Snohomish 98290 337-3528 <br />Owner Mailing Addre:s City 2ip �Phone <br />Owner <br />Applicant Mailing Address City Zip Phona � <br />Describe Proposed Work <br />PROJECT ADDRESS (if knnwn) <br />new house <br />Blvd <br />Atlach four (4) copies of plans for proposed work - Dww to scale and note Ihe following if applicable: c�1p�.f�; $,Si5. ;� <br />•Property Unes 'Outline and dimensions ol all ezisting and proposed stmctures on Ihe lot •Ezisting and pYoposed utiliUe3"� '��� <br />��cH �,�o. �c <br />•Centedine of sireet •Indicate P'oAh •Show any proposed grading changes •Show measurements corue� .., =n <br />PERMIT CONDITIONS: HOOQ09�.'..� <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. a�+TE� �"^-'�0 <br />2. Ail work shall be performed in accordance with this permit a�d current City of �Yi e2�ft`,Design and <br />Construction Standard� and Specifications. �=��"' 37�.-'�' <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEA:7.+800-'4a4-�55. <br />C��ECi: >^"' -.� <br />I [ustall tm inlillration Irench built si, p�r lhe city's `.Rr.;ideNial Roof Uownapoul S}'steni' d�s�lail an� <br />sirud as per die city's Table ILI-3.2 "Ruot'Dow7�,pou1 Syalem Siziu,q' slFy�le�l to ll�is pennit. 'll�e <br />irdilh�sdiun Uei�ch shtdl be no closer IliEm ; faet �o mry up slopc uropetly Inte or fom�dalion uor clos� <br />Ihan 10 frel lo :my du�vuslope pro��erty line or Youudalio�s - tui�ii location shall be field �ippro��vd b� <br />Public Works ��pec�or. C's�ll Prblic R�odce tor :w intipec[ion pria� to coveriqq h�encl�ea. <br />S. Provide tour ofi�sh'e�t (otl�cas�meut) p:u•kiqq slulla. <br />G. 1'.xcavat rd msderi.d trotn 16i5 site shall b�� hmded snv.ry to sm �pproved receiviug sit� or, witL tlir <br />Public Works Livpeclors prior approval, may be used h� �ill in Irtv ;vcn.y on Ihe lot. f?:ccav:�lcd <br />mat�rial rho-dl i�ot be u�oimdc:d so <�, to create drtuuaL¢e or eroyion problem� ou acljoiniue propiiti�s <br />� Gr �� �l�d-�7 <br />FINAL INSPECTION Dala <br />Approvea as Consiructed <br />W` <br />r <br />��A <br />V♦� <br />� <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF (:ONDITIONS <br />Tho undersigned ownedapplicant hereby agrees lo hold end save hartnless <br />the City of E�erett Irom any and all claims for Aamages, costs, eapenses, or <br />causes nf action that may arise because of mstallation and maintenanse of <br />1he impi ovement or olher nght-of-way use hereto applied for and further agrees <br />to remo�e same upon notice from the City and to replace public property <br />damagec'thereby. „ �i <br />r �� K � � `U�,. � y,`9� <br />Signatur �IApplicant Date <br />WORK AI.THORIZED BY THIS PERMIT MUST BE STAflTED WITHIN 180 [1AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. 7HIS PEFMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURATION. 1 <br />