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� �plication For <br /> PUBLIC WORKS PERMIT Date 3-5-96 , <br /> PUBLIC WORKS DEPARTMENT Public Works PermM A' ��_�p <br /> TO POSTING '� ° ° '�' 32°°�°"S�'�' <br /> Everett,WA 98201: 259-881 Q guilding Permit A 51032 <br /> f,i t 1 Ir� P f.;� Y� � 1 � f. t i_, r � . � ['i i'. . <br /> TYPE OR PRINT ONLY ,, ° _ . �; �,; p��,c Workc Fea$ �~, _ <br /> .� '' , : ' ' � � <br /> ' � ' . , � _ . �. <br /> Theo Conetruction PO Sox 2065;?Bothell 980b1-2065 206�486-7643 <br /> Owner Mailing Address i� •�. � �� _ � ir'7�n i-, �'� php�: <br /> ln r rfi t-:: f�_ -. C r_^� r�� -� L-: .. ._4 ` <br /> 3 . i � � � Ci � � r � �� � � <br /> O [ ir� rli , - r <br /> Umer Ted or Diana Selin '`� � � � w , � ' � , " ;� �' , '� c; � c � <br /> Y:. 'N' O. f�. y- t � f f11 r-. � . .� �l i G i. _ <br /> �IC3fll 1 � � P �� r�`� <br /> APP Mailing Address Crty • Zip Phone <br /> Describe Proposad Work new house � <br /> -- � <br /> s <br /> PROJECT ADDRESS(if known) 1:029 Paine Field Way Lot 2 SP 1i24-94 � <br /> Aflach four(4)copbs of plans for proposed work-Draw to scale and note the following H apolicabfe: � <br /> 'Property Lines 'Outline and dimensions of all existing and proposed stmctures on ihe lot •E,.isting and proposed utilRies O <br /> `Centerline of street •Indicate North 'Show any proposcW grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspectio�shall be made 24 hours in advance-phone 259-6810. O <br /> 2.All work shall be pertormed in accordance with this permit and cunent City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-900-424-b55S. � <br /> t. Rooflop drainage shall be dischatged: � <br /> • To the sile's sforni chain syetc�m (private or public) O <br /> • To a resideutial roofdotmapout Kysleut Jesig,tred per seclion 4-9.4 ofl6e a <br /> city standards <br /> � Unto splash blocks <br /> 'Ihe melhod selected will Ue subject to Public Worke Inspector approv;;!_ <br /> D� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ���/' � The underslgned owner/applicant hereby agrees to hold and save harriess <br /> 7�.<ti 3/ig��6 the City of Everett irom any and all clalms for damages,wsts,expena:�,or <br /> Approv Construction Date causes of action that may arise because of Installation and maintenance ot <br /> the improvemen�or other rigM-ot-way use hereto applied for and further a9rees <br /> to renov me tice from the City and to replace public property <br /> � �/Q'S dama thafeb <br /> �F L INS N � Date <br /> Approvad as Constructed . <br /> � (� C... �2�7 <br /> Sig ture of Applicant Date <br /> WORK AUTHORIZED BY 7HI5 PERMIT MUST BE STARTED WIIHIN 180 DAYS OF PER T IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> CAMPLEf10N.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE ORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />