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Date-5/5/95 �C ���.TlNG_Ai_�1'z��9B <br />Application For <br />PUBLIG WORKS <br />Print or Type Only <br />Select Home� Inc <br />Owner <br />Describe Proposed WorR <br />� <br />PERMIT� <br />c'[ <br />O <br />b <br />O <br />� <br />fi <br />N <br />12811 8th Ave W 41A201 Ever <br />MailingAddress �G�' <br />ti <br />� <br />in <br />M�ilingAddresa ^� <br />New house - Basic 101 <br />Project Address (if known) q032 We� r►1�� I <br />a�c�ni��l <br />CA r' O O.i' G� <br />d [� Ql ,-i eA (W <br />p b� Ml 'l� '1F' <br />e�i,t,t"' 98204 <br />t� �r ti� <br />o ci a r�..'� o �.zi ' <br />a�i�i 5i��no-o' <br />ty Zin <br />New model home <br />Publlc Works Permit a _ ��� <br />eiaa�oeo�.s y8�S7 <br />Public Warks Fea $ <br />Tatal Fae <br />less Roo� Fee Paitl $ �j <br />B�IafceD�a O �p /'� <br />Ifl U I�^�., uj f�l <br />w <br />� M `O l�' 1'_� <br />�13rA00(r� � ry" <br />��—� �-Phyne � <br />G� (i N.• fY. 41 �� <br />p �il O IJJ C� �"� U <br />nt-o afnn�� <br />n a r.� i.� z' <br />nr. 3�c tn in n� c� <br />Phone <br />Attach four (4) copies of plans �or propos�d work - Draw to scale and note the following as spplicable: <br />• Property Lines • Cer.tedine of stieet <br />• Outline and dimensions ot all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading change�; <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 O. <br />2. All work shall be performed in accordance with this permit and current City of Everelt Design and Construction <br />Standards ai..; Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-�a555. <br />q Keep city streets clean at all lunes. <br />1 C'urb guUer a�id sidewcll: ui Uie plat ar� new and unda�naged, a��}� damage ihereto shall b2 ieplaced ut the <br />discre6on of tlie Public Works Inspector. <br />t My chw�ge u� die driveway cut must be approved Uy die PW Inspector, widdi at prop line luiuted to <br />existL�g ��ron widtl�. <br />3 Adjust water boxe: to b ade at end of constmction. <br />d Ddvaways shall Ue co�iipletety cured befo�e �ivu�g on tl�em. <br />5 RooR�p drsivage shall be discharged: <br />• to the site's srorn� Jrain system (pnvate m� pubGc) <br />• to a residenual roof downspout s}'stem designed per secUmi 4-9.4 of the city standards <br />oi�to splash blocks <br />The mediod selecced will be suUject to FubGc Works Departement approval. <br />�/ <br />FINAL INSPEGTIQD! <br />Approved as Constructed <br />���IFa/ PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City ot Everelt trom any and all claims for damages, wsis, <br />expe�nses, er causes of action that may arise hecause of installation <br />and maintenance ot lhe improvement or other right�of•way use hereto <br />app i� for and further agrees lo remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />+ 20'�`7 �i-v�/ <br />Signature of Appl' ant � �ale <br />WORK AUTHORIZED BY THIS R RMIT MUST 8E STARTE� WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />VANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />