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/ <br />�' <br />� <br />TYPE OR PRINT ONLY <br />ApDlication For <br />PUBLIC WORKS PERMIT <br />BALTZELL <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireel <br />E�eT�OWPQSTIN2�9�e�� � 4 �sse <br />12420 ROOSEVELT RD SNOHOMISH 98290 <br />Dato 5/2(1/q7 <br />Public Works Permit !1 —__��1 / <br />Building Permit x 55195 <br />� <br />Public Works Fee $ <br />360-794-6650 <br />Owner Mailing Address City Zip Phono <br />Applicant Mailing Address City Zip Phone r� <br />Describe Propased Work <br />PROJECT ADDRESS (if known) <br />HOUSE - BASLC 1226 <br />SNORT PLAT <br />Attach four (4) copies ol plans for proposed work - Draw to scale and note the lollowing il applicable: <br />•Property Lines 'Outline and dimensions ol all existing and pmposad structures on the lot •Existing and proposed utilities <br />•Cen�erline of street •Indicale NoAh •Show any proposed grading changes •Show measuremenis <br />DO NOT WRITE BELOW THIS LINE p �lqg <br />PERMIT CONDITIONS: BUII�IFX'i 729.70 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-88��I� �,pp <br />2. All work shall be performed in accordance with this permit and current Cit�q,f��C�;�p and <br />Construction Standards and Specitications. q,gp <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE F��-80��-�1-5555. <br />q 31123 <br />SEiIER 70.00 <br />1 Av prr puhlic «•nrks approved ai�e pl.m UTILITY DEV_, ^^ <br />lus�tdi �n intiltr�fiou tmnch built �H per Section 3-2.6.2 smd <br />ot'tl�e city <br />`;IU17111V:1ir1 \f swagrmru� M:uwal (copy'� sly�led to tl�is pen��il).' nr*-���i�m:u�an i��rr�ct�r <br />�,. ... <br />closrr ih:w 5 tc��t to ;ma up :;lopc propeiiy linc or lonndation nor closcr t�� (i��t to ,my d <br />�,r���,,,ii� lui^ nr ti,nnd;ihnn �':dl Pnhlic 1Vork� liir an mti�n•clian prior te� coceriq¢ h�enchec <br />3N's�`'j5� <br />ACKNOWLEDC:EMF'di OF COIJDITIONS <br />��^^�'��.. � The undersigned ownedapplicant h;:reby agrees to hold and save harmless <br />'�^'o' � the City ol Everett Irom any and all claims fur damages, costs, ezpenses, or <br />A roved lor Const/uction " Date causes of aclion that may adsc Uecause o� instellation and maintenance o1 <br />P A ihe improvement or other rigM-ot-way use hereto applied for and fuAher agmes <br />�-, /j „ �f�`x� to �emove sa e upon notice from the Ciry and to replace public properry <br />�i �//l / 1//_ damaged t y. <br />�,e�v-�, �,rtc / -7 — 9 7 <br />FINAL INSPECTION Date <br />Approved as Conslructed � � <br />Signature o plic� t Date <br />VJORK AUTHORIZED BY THIS PERMIT MUST t3E STARTED WITHIN 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />CC:MP�ETION. THIS PERMIT MAY BE CANCE�LED BV THE CITY UPON ANY STOPPA�E OF WORK ON THIS PROJECT OVER 90 OAYS DURATION. <br />