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oa�e3_�3� TO P4STING �/�a � P����,��,�,P��m��. 9z. o9.B_ <br /> Application For eino oeoi • 759fi� <br /> PUBLIC WORKS PERMIT P°°To;;F�sF°e s — <br /> Le55 AO�I Fee Paid S <br /> , f. . ':^i�� <br /> Print or Type Only 8����=�c�� S ��-�� <br /> Select Homes 237 Elm Sc Everett WA 98203 Randy Clark 258-1503 or <br /> Owner Malling r.�dress r City� . -Zip �. , �� I Phone �348-1320 <br /> Owne:• . . . . , . . , , -- . . . ... . , . <br /> Applicam Mailing Address City Zip Phone � <br /> N , <br /> Describe ProPosed work new construction Lot 21 Maple If107 ! <br /> /'��j3j 1\ W <br /> Project Address(il known) t-61��'� — �� �1J� SC � <br /> Altach four�4�copias ot plans tor proposed work- Dra��to scale and note Ihe followinc�as apUlicable: � <br /> • Properry Lines • Centerline ot streel � <br /> • Outline and dimeosions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed gradinc� changes <br /> • Ezisting and proposed utilities • Show mezsuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls For inspeclion shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.Ali work shall be perlormed in accordance wilh�his perinit and current City of Everett Design and Construct�on <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 40 hrs.be(ore you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> 4 . In�tall ror.k construction entrance bPhind drivewav as per r_iT.y <br /> ht.andard #20R �n�1 ero�i��n control. as direr_ted hy Public Works O <br /> In�pentnr, <br /> 5. Keep r,i,`.v screets r_lean at all timas <br /> 6. rurb �utter and sidPwal.k in the nlat are new and i�nciama�ed, � <br /> anv �3ama�e thereto shall ha r�placFd aY, tha discretion of the <br /> Puh7 ic Wnrks Insper.t.or_ //\ <br /> 7 . An;✓ chan�e in r,he drivewav r_ut must be approved hv the PW Tn- �/♦ <br /> Spectnr, width at, prop line li_mited to existin� apron widt.h. O <br /> t� . Conner.t. all roof, var�l anri drivewaY drains to storm drai.n <br /> svstem prnvidPd tn l�t. � <br /> 9. Ad,ii�st. water hoxes i:o grade ar end of r,onstructi�n . <br /> 10. Drivew�vs shal7 b�� .r,oml�lFtp1 �� r,ured hefore dri-vi.ne nn them. <br /> r <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ��� The undersigned ownedapplicant hereby ag�ees to hold and save harm� <br /> � � less the City of Everett Irom any and all claims lor damages, cosls, <br /> • A capenses or causes o1 aclion Iha� may arise because ol installation <br /> 'j —/�� � —�U�et'7 and maintenance of the improvement or other righPol-way use hereto <br /> k � �^ Tppiicd tor and further &grecs to remove same upon notice ��om �he <br /> �£ Approved lor Cons tion Date Gt '�nd 10 repl� e public pr erty damaged thereby. <br /> �� �f�C' ��c�-r�ct� ��� <br /> ���_�,: €;—ii- � z_— A/�/,(r <br /> FINAL INSH[CTION Dale �L� �/l�����' �� �—��" <br /> Approved as Constructed Signatr��e of Applicant Date <br /> �ArE�� PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Cedar5treet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> ; Everel�.WA°8201 BE DILIGENTLY PUNSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY TtiE CITY UPON ANY STOPPAGE OF WORK ON THIS� <br /> PROJECT OVER 90 DAYS DURATION. <br />