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! <br /> , <br /> 1/24/90 / <br /> Date Pubbc Woik;Pcrmi�+ ��' C' <br /> Application For DIJ9 Depl • 0/23816 <br /> PUBLIC W�RK.S PERMi?' P°h°°W°��=F« - <br /> .a�:,�F�� s <br /> Less AnPI.Fee Paid S _ <br /> eaianr,e Ouc $ ��� <br /> Print or Type Only <br /> Select Homes P.O. Box 708 Muki.lteo, WA 98275 827-8196 <br /> Owner Mailing Address City Z.ip Phonc <br /> Owner <br /> Applicant Mailing Address Gty Zip Phone <br /> Describe Proposed Work New sinqle family residence, Lot 5, Glenhaven Height.s �� <br /> Project Address(i� known� � �'�� "'T��� ���--AcC �J � � <br /> _ � <br /> Attach four(4)copies of plans lor proposed work� Draw tu scale and note the followino as applicable: � <br /> • Property Lines • Centerline ol stree; ♦^ <br /> • Outline and dimensions of all existin9 and • Indicate North �� <br /> proposed structures on the lot • Show any proposed c�rading changes <br /> • Existing and proposed utilities • Show measuremeNs � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-Fhone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4& hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> 4. ANY CHANGE IN THL� DR.IVEWAY CUT MUST BE APPROVED <br /> BY THE PUBLIC WORRS INSPSCTOR. O <br /> 5 .CONNSCT DOWNSPJUTS 'PO THRU CURB DRAINS. <br /> G . KF,SP CITY STRfiETS CLSAN AT ALL TIMEu. <br /> 7 .ANY DAMAGB TO THE r,URB AND SIDEWALK W.ILL BE REPAIRED L� <br /> TO THE SATISFACTION OF THE PUBLIC WORKS DEPT. � <br /> � <br /> O <br /> a . <br /> ��j ACKNOVJLEDGEMENT OF CONDITION:i � <br /> �1 The undersi9netl uwner/applicant hereby agrees to hold and save harm- <br /> �— less ihe City of Everett Irom any and all claims tor damages, cosis, <br /> ezpenses, or causes ol action !hat may arise because ot installation <br /> ��<,;/i .., � / ' /9v and mainlenance of ihe improvemeM or niher riyht-of-way use hereto <br /> 1�25C_ i— apUlied for and further agrees to remove same pon notice Irom ihe <br /> Approved for Const�dion Date Ciry� nd to replace ublic pr p rtY dama ed th by <br /> � <br /> 2?`J�l.rin-- l� / � :. .� 7 <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signa ure ol Applican �e <br /> everett PUBLIC WOFKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BG <br /> Everett WA 98201 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK OIJ THIS <br /> Phone:259-8810 PROJECT OVER 90 DAY� DURATION. <br /> � <br /> I <br /> � <br />