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� - i 3 -z�-.� � � � . <br /> Date 3 2 �JS -` Publi^Wa�MSPermn� �.�L�— <br /> APR �J 9 199 eiec own .�ZB�7 <br /> qpplication For ,TO �O�T�NG _.----��" � <br /> PUBLIC WORKS ,�ERMIT P�b;o„FcaFea s <br /> ���' lesa�ool Fee Pa�n S <br /> -� i �� �", , - �- r., r .� r_, Baiance Due S �� <br /> Print or Type Only s �� �., r.� � . � � , , <br /> p- . <br /> n� r'� �� i—� .r r_.� y'� ; � � <br /> �:� ❑1 . .,. ' .., .-1 _ [`l <br /> . �, ♦ .. . . ,� ':•• . (..: <br /> Roger`s Constructiou 4719 119ttiapl SE^ Ever'ett `•Y482i��8'P 337-1885 Phonr. � <br /> Mailin;Atldrei's•�. t— eCi�ii� ci � ZiP <br /> Owner � i �. � r� r: r�. ;� ��� -:. <br /> �� ,� tL� 3: �_• r � r� bJ C_1 �.i Cn i 'i <br /> fJ. 1� L' fL. f_: ' iJ !-' I, f� G =�2 bl t�l <br /> ' f) I ._1 1�1 ..1 �i Cl- � Q O UI ' <br /> RogeT Maynal(1 <i xc iii .� y: �-� cn r._, a � a cn 5� �_� <br /> Applicant <br /> Mailing Address City Zi� Phone <br /> New house — Basic 314 <br /> Describe Proposed Work <br /> 25 W <br /> �GZ p /5� f�V� SE Lot 1 Shart Plat �-93 1� <br /> Prolect Address(if known) r <br /> � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note me lollowing as applicable: � <br /> • Property Lines • Centedine ot s,reet <br /> • Outline and din.ansions of all existing and • Indica�e Ner�h <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Ezistirg and proposed utililies • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOK'THIS LINE O <br /> PERMITCONDITIONS � <br /> 1.All calls for inspection shall be mede 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be pedormed in accordance with this permY and current City of Everett Design and Conslructlon I <br /> StandardsandSpecifications. � � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> !. RoeBop clrainn�e sl�all be di�cl�ar;ed: O <br /> • l'� the ai�e's stot7n drlin system(private. or puhlic) <br /> • To tt roeidenlial ruuf dutvnepoul syslrtu designed per secliun d-9A uClhe <br /> cily st•.md�u�ds � <br /> • �?nto spinsh blocks � <br /> 'Che melhoJ,electecl will be subject tu Yublic \Vorks Dep:u•tement a��provnl. <br /> �.Listall G' sidesen�er inlo no�il� end ofm.m hole (itlio laiockout - core drill). Trenc}iing iu O <br /> P�ved nreas must be iilled�vith control density backlilL Call C:uro�i '1'o�lei'son("a? 339- A <br /> 7�104 for a consultation prior to beeinuiva constntclion. <br /> - li <br /> f ACKNOWLEDGEMENT OF CONDITIONS <br /> // 1 <br /> f`L� L�q���YS� The undersigned�wneqapplicant hereby agrees to hold and save harm� <br /> less ihe Cdy ol Evere�l Irom aoy and all claims for damages, costs. <br /> �`_�� e.Fenses, or causes ol action that may arise because ol installation <br /> � `S ao maintenance ol Ihe improvement or other right-of-way use hereto <br /> applied for and further agrees to remo:e came upon notice Irom Ihe <br /> Appr or on u ' - ��e City and to replace Public proPerry damaged ihereby. <br /> � /.. �( � <br /> / / �_ :1- r�. f `/ ,�...i/ . <br /> INAL N Date _ � Dale <br /> qpproved as Constructed Si ture ol Applicar�b <br /> WORK AUTHORI BY THIS PERMIT MIIST BE STARTED WITHIN <br /> �Ar� PUBLICWORKSDEPARTMENT 1B0 DAYS OF �ATE PERMIT IS ISSUED AN� 7HEREAFTER IS TO <br /> 3200CedarSireet BE DILIGENTLY PURS iED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CI'Y UPON ANY STOPPAGE OF WORK ON THIf <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURHTION. <br />