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�--y Application For � <br /> �i__`� PUBLIC WORKS PERMIT Date s-Zo-9� � <br /> ,�,�„ <br /> PUBLIC WORKS DEPARTMENT Public Works PertnR M <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 � <br /> Building Permit k 55204 <br /> T�J POSTING �" 1 s ,s� <br /> TYPE OR PRINT ONLY public Works Fee$ z�Q]� _ I <br /> Hearthside Homes Inc 2911-1/2 Hewitt Ave 116 'Everett 98201 303-9665 <br /> Owner Mailing Address City Zip Phone <br /> Owner I <br /> Applicant Malling Address City Zip Phone I <br /> Describe�roposed Work <br /> new home �l—u� �•�� � <br /> BUILDIMG 786.70 � <br /> p���«�BS <br /> 1£p�IWICAL 60.00 � <br /> PROJECT ADDRESS(if known) 2025 E Grand Ave Lota 3 �Y �'� <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the Iollowing if applicable: M TLp� �3 � '� <br /> •Property Lines 'Outline and dimenslons ot all existing and proposed structures on the lol •Existing�proposed�s� O I <br /> 31174 � <br /> •Centerline oi street •Indicate North •Show any proposed grading changes •Show measurerr�nts � <br /> DO NOT WRITE BELOW THIS LINE UTILITY DEV <br /> PERMIT CONDITIONS: �qb,pp � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-881pOTAL. 3008.60 <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design an�HEK <br /> Construction Standards and Specificaticros. p pR gyb <br /> 3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBER 1-800-424-5555. � <br /> I K.cep cih� siroels cican al ;di times. � <br /> ?. Li�l:�l S WIIIC SI(ICW:III� IICIIIIIII C7(Iti�lllF;l'Ufll illl(I�III(Cf ;IS �1Cf 51811(I8f(I�I(111 N10G 011 IIII5 prupe�ly's fidl O <br /> 11�001;ItiC � <br /> e Adjust warer boxes to rrade at end of constniction. <br /> ,. P.00llop dr:tinagc �hall bc dischugcJ to tl�e housc's sidc scwcr. <br /> � Tlu� hous; �It�ll havc a sui�Je �idescwcr connection to the ciry sewcr main. <br /> ��/� /� ACKNOWLEDGEMENT OF CONDITIONS <br /> C�%��'�� _ � // �� The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> � the City of Everett from any and all claims for damages,costs,expenses,o� <br /> Approv�structi Date causes of action that may arise because of insta�lation and maintenance of <br /> the improvement or other righFof-way use hereto applied for and further agrees <br /> to remove same upon notice from the C%y and to replace public property <br /> �—�,y � damagedthereby. <br /> FINAL�NSPECTION Date <br /> Approved as Constructed <br /> � <br /> of Appiicant Date � <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO � <br /> COMPLEf10N.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAYS DURATION. <br /> � <br />