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1 �� 1 -4-94 Puolro Worka Permu� � <br /> ' oa �_ � Tn pn TiN�_� 431 4 <br /> C � B�av Dsot• <br /> P Appticatlon For <br /> PUBLI�WORKS PERMIT PuCucWorksFes s <br /> Tot�l Fee <br /> Leu�DD�Fee PaiE Z <br /> e�ian[e Oue S ,p' <br /> Print or Type Only � g 8 $ � g g g g g g � <br /> � � � � M � � � g � � � c� <br /> Se lect Homes 2 3 7�E 1 m S t E v e r�l�' 203 258-1503 phone <br /> p.� MaiNng Add � �Y � Z�P <br /> Owner �� � ���� ��� � � � � � <br /> Owner .�.�. <br /> Applicant <br /> Mailing Address Ci�y 2ip �ho�e � <br /> C <br /> Describe Propos� . Work _ <br /> new house L <br /> W <br /> Pro�ecl Atldress(if known) <br /> 5624 lst Dr W Lot 8 Hanabrook 4 � <br /> � <br /> Attach tour(4)copies of plans for proposed work- Draw to scale and note ihe Icllowin�as applicable: � <br /> • Property Lines • Centerline of strael <br /> • Outline end dimensions of all existing znd • Indicate North <br /> proposed slructures on the lot • Show eny proposed grading changes <br /> • Exiating and proDoaed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspectbn ahell be made 2A hra.in advance•phone 259•8870. <br /> 2.All work ahall be peAormed in eccordance with lhis permit and currenl City ol Everelt Oesign end Conetruction <br /> Stenderds and Specificatlona � <br /> 3.Cell Location Underground Servlce 48 hrs.bs'�r^You dig.TO:I FREE NUMBER 1•800�424•5555. <br /> 4. I�e1s1 rock comtniction eMrance aehind drivawY as per city O <br /> pandard�208 and�rosfon coMrol ac dincted by Publc Works � <br /> Insp�ctx. <br /> 5.KNp cNY�tnMs cNsn at a1 times //� <br /> e.Cy��pl��and ddw+sk M Ihe plrt an nw+and midam�g�d, y/ <br /> any damap�IMrNo chal be ropbced rt the diccretfon oi the O <br /> Publc Worla knp�clor. <br /> 1.My chanp�in tM driuwvaY n d to e�dclMg �pron wid►he� In- � <br /> �peMor,wldth N prop drafns ro storm dr�in <br /> 8.Corm�cl �I roo1,Y+rd aod d�ivew�Y <br /> sy�t�m provided to lot. <br /> 9.Ad}ud wn�r boxes to pade at end o(condmctlon. ACKNow�eocEMeNr oF coN�inoNs <br /> � 10.DrNw+�Y�=hN bs compiNsy curod b�ioro dtiving on them. <br /> The undersignetl owner/applicant hereby agrees to hold and save harm• <br /> � less the Gity of Everett irom any and all claims for damages, costs, <br /> er.penses, or causes ot action that may arise because of insteltation <br /> ���� C �_ ^ 1_ ^ ��� and maintenance ol the improvement or other righfobwey use hereto <br /> F-KX_+ I applied for and turther agrees to �emove seme upon notice � m the <br /> ApD'oved lor Con�s/truc�ion ���e City �d to re�ace��,Y dama9eQ 1hereby <br /> ✓'_� � j� �i/�� �C/ <br /> S/i-�Y /-L� -� v <br /> FINAL INSPECTION Date Dat <br /> Signature of Applici.n <br /> Approved as Constructed ydORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITH�N <br /> � PUBLICWORKSDEPARTMENT 180 DAYS OF DAl"E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everet6 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />