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Application For � <br /> � PUBLIC WORKS PERMIT Date 3-5-96 <br /> PUBLIC Wt�iKS DEPARTMENT Public Works Pertnit M • � O� / <br /> 3200�Cedar Street <br /> �� n POSTI�lG �erett,WA98201 259-8810 guilding Perrtcit M 51034 <br /> - k'' <br /> c.� C :., c G 'f.i �i f.i 1 i �� �ii " c �ti �� �''•,y}� <br /> y ?. �n , <br /> TYPE OR PRINT ONLY » in � r,-� .s c �n r:; c, �F ci Pu�c�Wqd�s Eee�4' K/ <br /> r� ; "C .• f. I� -(,1 l �^ f,: Y.� � �O N [ rii r-. <br /> M .!+ I() .n r' N� Ifl N� H� ♦ .� CI <br /> ��� yl M1 �P �• <br /> Theo Construction PO Bbz 2D65 Bothe11�-98041-2065 r;206-486-7643" " <br /> Owner Mailing Addrest�. .. '-'. c; � . City r� c_ -�.ziP �,. �- y.PJione <br /> � In c- � lri (� i 47 a •� <br /> �(y h C l9 . .. �J /'� 'I S S � O GO C'.1. S � �-.. 1-. C1 <br /> �i O r� � r i �: r C� ' r � f� �! C] O fi'i C.� 4J 6 G' �'i �..i <br /> Owner Ted or Diana Sel�n �� ' � ! '< �. ^ � �! « � n � � w �,, a o u T <br /> 4f o, � y� r:i :.r i �: n iJ rfn n vt rr: ?, r_ n, U+ �, rj •7 <br /> Applicant Mailing Add2s5 City Zip Phone <br /> Uescribe Proposed Work nea houae � <br /> � <br /> � <br /> — � <br /> PROJECT ADDRESS(if known) 11017 Yaine F1.eld Way Lot 4 SP 1124-94 � <br /> Ariach tour(4)copies oi plans tor proposed work-Draw to scale and note the tollc*:ving if appiicable: O <br /> 'Property Lines 'Outline and dimensions of all existing ard propt�ed structuras on the lot 'Ezisting and proposed utilities <br /> �Centerline of street 'Indicate North 5how any proposed grading chanaes •Shuw measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All wortc shall be performed in accordance with this pertnit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-6655. � <br /> d. RooY.op drainage shall be di�charged: � <br /> • To the aite's �lorni ctrain syetem (private or publicl O <br /> • "To a re::ideulial roof Jownepuul syslem Jesig�i�d per acclion 4-9.4 of U�c a <br /> city ct:uidsvds <br /> . Onto splash blocks <br /> 1 i�e method a�lected will bc subject fo Public 1�Vorica Departement apptoval. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ��"� � /""`� G!/ ��/�� The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> the City of Everett from any;nd all claims for damages,costs,ezpenses,or <br /> Appro�onstruction Date causes of action that m.�.,ri;e because of installation and maintenance ot <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> � to remov me upon notice from the City and to replace public property <br /> i ama <br /> S te <br /> Appmved as Constructed � � � � '' � <br /> Si nature of Applicant � Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WIh11N 180 DAYS OF D ERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> CAMPLETtUN.THIS PERMIT MAY BE CANCELLEO 8Y THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />