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Date �-�s_o� <br />c� �13�2�•4 <br />ApplicationFor Tr ���T��� <br />PUBLIC WORKS PERMIT ��`�-��- <br />Print or Type Only <br />HEARTHWOOD HOMES <br />Owner <br />OWNER <br />", ` <br />PO BOX 2355 LYNNWOOD WA 98036 <br />�. Mai4mg Address. . . City Lip <br />Mailing Address Ci1y Zip <br />Describe Proposed Work NEW SFR <br />Project Address (il known) <br />s�o�,� wo,k. �e,m�� . 9Z o 7z � <br />eiyq. oeo�. y 92 35745 <br />Public Warks Fec <br />Tolal Foe S <br />LM5 Aopl. i-ce Pmd 'J <br />paianc¢ Due � ��7 � <br />771-1 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note ihe iollow;ng as applica6le: <br />• Property Lines !� Cen'terline of stree� <br />• Outline and dimensions of all existing and • Indicate North <br />proposed �Iruchlres on the lot • ghow any proposed grading changes <br />• Existing and aroposod utilities • Show measii:•ements <br />Phone <br />PERMIT CONDITIONS <br />7. All calls for inspection shall be made 24 hrs. �n advance - phone 259-8810. <br />2. Ali work shall be performed in accordance with this permit and current City of Everett Design and Con�� .;ction <br />Staiidards and Specifications. <br />3. Call Location Underground S=rvice 48 hrs. before you dig. TOLL FREE NUMBER 1•800-$24-5555. <br />4. THE WETLAND AUD THE BUFF�R ARF.A ARE TO REMAIN 1N THRTR <br />NATURAL STATES. NO CLEARTNG 0; CUTTTNG OF VRGF.TATTnN �R - <br />CHANGING uF DRAINAf�E PATTF;FNS WILL BE PF.RMITTED IN 7'HESH AkF.AS <br />C <br />Appraved <br />Approved as Constructed `� <br />� PUB�IC WORKS DEPARTMENT <br />,V�3200 Cedar St�eet <br />Everett, WA 98201 <br />Phone:259-8810 <br />i <br />Date <br />� <br />O <br />� <br />Y+ <br />� <br />a <br />ACKNOWLEDGEMENT OF CUNDITIONS <br />The undersigned owner/appiicant here6y agrees to hold antl save harm� <br />less the City of Everett Irom any and all claims for damages, costs, <br />expenses, or causes of aclion thal may arise because ol installation <br />and maintenance of �he improvemenl or other right-ol�way use hereto <br />applied for and turther agrees to remove same upon notice Irom the <br />�ify ai�d to replace lic property damayed ihereby. <br />Signzture of Appli nt � Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUF.D AND THEREAFT�R IS TO <br />BE DILIGENTLi PURSUED TO COMPLETIQN. THIS PERMIT MAY BE <br />CANCELLED 8Y THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />