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Date 12 2 e5 <br />Application For <br />PUBLIC WORK� PEFiMIT <br />Print or Type Only <br />PUDIic Works Permil e �N �T <br />aiaa� oan�.• 85/15846 <br />Pu�llc Worka Fca s <br />Tola� Fea <br />Less ApP� Fee PeiC S <br />Beianca Uue S ?���0 <br />�.� , _. <br />Fletco Const. Znc. 17018 15th Avenue N.E. Seattle. WA 98155 363-0316 <br />Owner Mailing Address City Zip Phone <br />Same <br />Apr,icant Mailing Address <br />Construct single family residence <br />Describe Proposed Work <br />Lot 16 <br />Project oddress�if known) 10577 — 4th Or. c_W_ Trn 16 of �oA,r <br />Zip Phone <br />Attach four (4) copies ol plans lor �roposed work - Draw lo scale and note the lollowing as applicablr: <br />• Properly I_ines <br />• Outline and Jimer.sions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline ol slreet <br />• Indicate Norih <br />• Show any proposed grading change� <br />• Show measurements <br />1. All cells for inspection shall be made 24 hrs in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with this permit and current City ol Eve�ett Design and Consiruction <br />Standurds and Specifications. <br />?. Call Location Underflround Service 48 hrs. before you tlig. TOLL FREE NUMBER 1-800•�:24•555$. <br />4. Th:s lot depends on a lift station £or sanitary sewer service. The City has <br />not accepted the lift station for operation and maintenance as of this date. <br />Occupancy of residence will not be allowed until the C�.ty accepts the lift <br />station. <br />5. Down spouts from the house are to be tight-lined to the curb drain. <br />6. Any grading of this lot is to be done so as not to impact the adjoining lots <br />with rain-water run-off. <br />7. Sidewalk is new and unbroken. Any dart,aae to it will require replacement by the <br />applicant. <br />`�%� �-���- / --E -� �'6 <br />Approde r Construction Date <br />JL�V�U�Q/\V" `�\ \ � LI"L� <br />FINAL I ECTI N�� Date <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phoi�e: 259-88 t 5 <br />ACKNOWLEDGEMENTOf CONDITIONS <br />� <br />0 <br />� <br />� <br />O <br />a <br />Thc undersi�n=d cwner/applicant hereby ogrees to hold and save ha�m� <br />less �he City ol Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintznance ot Ihe improvemen� or other right-of-way use hereto <br />applied lor and further agrees to remove same upon notice Irom the <br />Cily and to replace public r erty damaged thereby. <br />, l�- . �� ��� 8� <br />Signature ol� pplica Date <br />WORf: AUTHORI BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PER'n�? IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLI' PURSUE.J TO COMPLETION. ThIIS PERMIT MAY 8E <br />CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />