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Date 6-21-90 /r <br /> r <br /> PuOLtWorksPmmil• �0�97 <br /> Applicalion For emp.Deo�.• 40/94909 <br /> PUBLIC WORK� PERMIT PueTolw Fee`ee 5 -- <br /> less A001 F�e Fa.�l 5�__ <br /> Print or Type Only o��,�«,,,� s�-.o- <br /> .—dorYh r PG � � D ���12 Bothe�l Wav SE #F129 Mill Crnek 98012 338 1486 <br /> Owner Mailing qdAr�ss ���Y <br /> Z'p Phone <br /> Owner <br /> Applicant Mailing Address Cily <br /> Zip Phone <br /> Describe Proposed Work New Single family residence LE-j.�— �9 �.T � <br /> � <br /> 3Z7 <br /> Project Address Iil known� � - lst Dr SE � <br /> Altach four(4)copies ol plans for proposed work• Draw to scale antl note the lollowing as applicable: � <br /> • Property Lines • Centerline ol st�eet _ <br /> • Outline and dimensions ol all existing and � <br /> proposed s�ructures on the lot • Indicate Nor�h �•g/�g rq0 P�:13F'� ODpqH;4Q5 <br /> • Existing and proposed utilities � Show any proposed grading chapges <br /> • Show measuremeNs <br /> {iU00i7.?286 Y.. . V /N <br /> 00 NOT WqI7E BELOW THIS LINE lii <br /> PERMIT CONDITIONS 1I�00�4909 O <br /> t.Ail calls lor inspection shall he made 2a hrs,in advance-phone 259•8810. �LGu 5599.00 <br /> 2.All work shall be performetl in acwrtlance with this permit and current City of Everett Desi n�p� 4' S L�0 � <br /> Standards and Specifications. 9 d ConstF <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-$00-n�;�555���p,47� � <br /> f• SRCH 84.50 � <br /> 4.ANY CHANGE IN THfi DRIVfiWAY CUT MUST BE APPROVfiD DkUW;� g��_,� <br /> N000069L3 � <br /> BY THB PUBLIC WORKS INSPECTOR. WRTER 260.00 <br /> 5.CONNECT DpWNSPOUTS TO PUBLIC DRqINAGE SYSTEM. �000�789(.� <br /> 7.ANYPDAMAGSSTOETHE CURBNAND SIDEWALKSWILL BE REPAIRTD SEW�� £;p,00 � <br /> TO THfi SATISFACTION OF THE PUBLIC WOR_.S DFPT. F���� I 4A10.00 'w <br /> v 117i-5 '.B13.CJ V) <br /> ::H,.L'1; >joc: n^ <br /> vw. ! O <br /> �. <br /> (��I" ACKNOWLEDGEMENT OF CONDITIONS <br /> —�� The und=rsic�ned oN•ner/applicant hereby agrees to hold and save harm- <br /> less the Cily of Everett Irom any and all claims br damages. costs, <br /> �„ Q � �l�- expenses, or rauses o� adion Ihat may aiise because of installation <br /> � � �o �9 9� and maintenance ol Ihe improvement or olher right�of-way use herelo <br /> Approved lor Co�struction Date applied for and lurlher a9rees to remove same upon notice Irom ihe <br /> �� ' City and to replace public property damaged ihereby. <br /> ��._� _ �_..�� �i <br /> FINAL INSPECTION � � � $ ` /', <br /> Approved as Consiructed Date � <br /> Sic�nature ol Applicant Date <br /> everett PUBUC WORKS DEPARTMENT WORI< AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI <br /> � 3200CedarSireet 180 DAl'S OF DATE FERMIT IS ISSUED AND THEREA�TER IS T <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV f <br /> Phone:259�8810 C�INCELLED BY THE CITY UPON ANY STOPPACE OF WORK ON TF <br /> PROJECT OVEF 90 DAYS DURATION. <br />