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� APPlication For - � <br /> PUBLIC WORKS PERMIT Date s-Zo-4� <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# D <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 Building Permit M 55205 <br /> TO POSTlNG '��N I 5 1998 <br /> TYPE OR PRINT ONLY Public Works Fee S� _ <br /> Hearthside Homes Inc 2911-1/2 Hewitt Ave 116 Everer.t 98201 303-9665 <br /> Owner Mailing Address City Zip Phone <br /> Owner <br /> Applicant Mailing Address City Zlp Phone <br /> Describe Proposed Work new home � <br /> � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) 2021 E Grand Ave Lots 5 6 6 � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines 'Outline and dimensions of all existing and proposed strucWres on the Iot •Existing and pmposed utilities <br /> °Centerline of street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance - phone 259-881 C. O <br /> 2.All work shall be performed in accordance with this permit and current Ciry of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> \I/ <br /> I Recp cilp circcts cle:m at aIl limes. O <br /> :. Inslilll S� WItIC siJew.dk Lahiod czisGu{;cwb :wd kutter :�s pei sl�uidard pluu N3U6 on ttus prop�ity's li�i <br /> lroulagc a <br /> t,. Adjust water boxes to erade ot cnd oPconstn�ction. <br /> '. RooHop cL.wiagr sl�;�l bc �ischar�;cd (o iLc houscs sidc acwer. <br /> 8' �lS ��U.f�i��Ct �/ '/Ci � Q .sl ✓�9�C. SjC�.(.�/' �FJNNC��1 i_�M Te� <br /> v <br /> � ri/� �.t,c.�'7/' HL4 n'L. <br /> ACKNOWLEDGEMENT OF CONDIT10N5 <br /> � � // � The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> � the City of Everett from any and all claims tor damages,costs,expenses,or <br /> Approv d for Con, ct:ov Dat causes ol action that may arise because of installation and maintenance of <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> _ to remove same upon notice from the Ciry and to replace public pmperty <br /> � 3_��� damaged thereby. <br /> FINAL INSPECTION Date `J� Y/ A � <br /> Approved as Constructed <br /> �r `7�'��� <br /> �gnat o ' ant �8 <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF UATE PERMIT IS ISSUED AND THEREAFfFR IS 70 BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY DE�AIJCEL�EO BY THE CIN UPON ANY STOPPA3E OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />