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Date 5—z3-90 <br /> P�eu�woa,aa,mn. ��/24 Z <br /> Application For BiEB�Oept�_9�?46p5 <br /> PUBLIC WORKS PERMIT PueTotaFrteLeC : <br /> LeSSNpp1.Fee PaiE S___ � <br /> Print or Type Only Br�e�«o�e S 2b"' <br /> Universe Const. 2529 - 189th St SE Bothell 98012 r <br /> 481-3366 Q <br /> Owner Mailing Adtlress Cily Z.ip Phone <br /> owner "1 <br /> Applicent Mailing Atldress City Lp Phone � <br /> Describe Proposed Worh New Sinqle Fami1V Residence W <br /> � W <br /> Project Adelress li(known) T.,ot 3f — u'�ges. a �D �ZO — �sT I�iZ $E � <br /> Attach four(4)copies of plans for proposed work� Draw to scale antl note Ihe lollowing as applicable; <br /> • Property Lines � <br /> • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicale North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS O <br /> 1.All calls for inspection shall be made 1•1 hrs.in advan�e-phone 259-8810. <br /> 2.All work chall be pertonned in accordance with this permit and current City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.6elore you dig.TOLL FREE NUMBER 1-$00•424•5555. <br /> � <br /> 4.ANY CHANGE IN THE DRIVEFiAY CUT MUST BE APPROVED � <br /> BY THE PUBLIC WORKS INSPFCTOR. <br /> 5.CONNECT DOWNSPOUPS TO PUBLIC DRAINAGE SYSTEM. � <br /> 6.K$HP CITY STRfiETS CLfiAN AT ALL TIMES. <br /> 7.ANY DAMAGH TO THfi CURB AND SIDEWALR WILL BE RE�AIRED (/� <br /> TO THE SATISFACTION OF THF. PCIBLIC WORKS DEPT. �/� <br /> O <br /> a <br /> ACKNOWLE, " '.'AENT OF CONDITIONS <br /> -- __ The unAersiqned owner/applicant herebv agrees to hold and save harm- <br /> less the Cily ol Everetl irom any and all claims for damages. costs, <br /> expen;;es, or causes of action thal may arise because of installation <br /> � ���4 �� _ �s`� and maintenance ol the improvement or other righ��ol-way use hereto <br /> Appwved for Construr,ti Date 2pp�ied for and furfher a rees to remove same upon nolice Irom the <br /> i ' � / <br /> / City and t epl. e publi roperty damaged thereby. <br /> ��L�� . �• L � ,5:� � �� <br /> FINAL INSPECTION Date / � <br /> Approved as Construc�ed gn re App icant ' .�1e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarStreet 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREA�TER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THI" PERMIT MAY B[ <br /> Phonc:259�8610 CANCELLED BV THE CITY UPON ANY STOPPAGE U'WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />