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Date 5 Z4 9O ououc Wor�a rarmi�• �/Z 3� / <br /> m Application For BIOp.Depl.• 90f24692 <br /> PU�L�C WORKS PERMIT PueecWorxsiee <br /> �� <br /> ,o�a�F�o s_-- <br /> p Less POPI.Fee Pa�U 5 <br /> O <br /> O O O V] O p O O O Ifl Balance�uc S �7-�� <br /> Pflnt Of Type Onl� `� � � ": °� � o � � � �' <br /> v] �t O O L� �t O O O O O b <br /> .-i �� �O U� .-� W C�1 �O ��? .-1 ln P <br /> O W Hi tlt tli +f- tll 1R M M .-� <br /> Ia Rock Home� I�. 16606 -�1s�Ave SEei Bothell 98012 465-9030 <br /> Owner � r•i Maili �A ess� p_ o�i ;� i �ity Zip Phone <br /> �Y' f.� 'U U' S Cc: 3 ^] W O �y1 + U <br /> N O O i al V U 1 � C� 1— O 3 G) l� W <br /> \ O _.r J W J itOaSO W ' � S <br /> Owner ro :< ni o_ z a mou � su� "n`� .. �� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work New single family residence <br /> W <br /> Projecl Address(il known) Lot 75 — Ridqewood Tarrace �'�� � �sr l7Z S� � <br /> Attach lour(4)copies ol plans lor proposed work- Draw to scale and note Ihe following as applicable: � <br /> • Properly Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate Nor!h <br /> proposed slruc�ures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Sl�ow measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be mad�24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordonce with Ihis permit and cunenl City ol Everett Design and Consiruction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service a8 hrs.hefore you di�.TOL!FREE NUMBER 1•500-424•5555. � <br /> O <br /> 4.ANY CHANGfi IN THS DRIVSWAY CUT MUST Bfi APPROVED � <br /> BY THE PUBLIC WORKS INSPSCTOR. ♦A <br /> 5.CONNfiCT DOWNSPOUTS TO PUBLIC DRAINAG6 SYSTHM. V♦ <br /> 6.KfiSP CITY STRfifiTS CLEAN AT ALL TIMSS. O <br /> 7.ANY DAMAGE TO THfi CURS AND SIDfiWALR WILL HE REPAIRliD <br /> TO THfi SATISFACTION OF THE PUBLIC WORKS DEPT_ � <br /> .\\�� ACKNOWLEDGEMENT O�CONDITIONS <br /> ��� The undersigned owner/applicant hereby agrees to hold antl sr.ve harm- <br /> - less the City of Everett from any and all claims for damages, costs, <br /> /� expenses, or ca ises of action Ihat may arise because of inrtallxtion <br /> ��^ � p 1�ncile� �^ I O_�� and mainlenance ol lhe improvement or olher righFol�way u �. hereto <br /> ��ti���' L applied I�r and luriner agrees to iemove same upon noti ,�:i Ihe <br /> Approved for Conslr ction Date City and to replace public nroperty damaged �hereby. <br /> �/d/C�"��"'-- ��-^G' 9i —�/I � //,� �f�i/�� <br /> FINAL INS?ECTION Dale / LLt-'�`c T'-'*u-LLa���- <br /> Appro•�ud as Conslructed Signature of Applicant Datc <br /> everett PUBLIC WORKSDEPARTMENT WU4K AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarSlreal 1B0 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everell,WA9B201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER�0 DAYS DURATION. <br />