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l� <br /> Date 1/24j90 n�encwo�esa��m�i. �G �'�t� <br /> Applica�ion For eie9.oep�.. 90/2 3607 <br /> PUBLIC Wt�RKS °ERMIT PublicWOMSFce <br /> To�T���� s _ <br /> Less Anni.Fee Pan g <br /> Print or Type Only B'�'�`�o°` $Zv "� <br /> Select Homes P O Box 706 Mukilteo. WA 98275 �3�x 823-8196 <br /> . Owner Mailing Address City Zip Phone <br /> lhmer <br /> Applicant Maifng Address City Zip Phone <br /> Ne Z <br /> Describe Proposed Work New si.ngle family residence, Lot 3, Glenhaven Heights, �T <br /> Project Address lif known) �� � 9� f�L��1:� -� � <br /> � <br /> Atlach four(4�copies of plans(or pioposed work- Draw !o scale and nole ihe lollowing as applicable: � <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes � <br /> � Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE Q$/OZ/9O S�7S$PM OOOAHS�S � <br /> PEFMIT CONDITIONS ��2�� <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and wrrent Ciry of Everett DesigBl�(al Constf�bn50 <br /> Standards and Specifications. P�,B� $60.00 <br /> 3.Call Location Underground Service 48 hrs.before you di;7.TOLL FREE NUMBER 1-800-�{5555.590.00 � <br /> E SRCH 84.50 <br /> 4.ANY CHANGS IN THS DRIVEWAY COT MUST BE APPROVSD ��`'' $20'� O <br /> BY THS PUBLIC WORRS INSPSCTOP WATER 460.00 <br /> 5 .CONNSCT DOWNSPOUTS TO THRU CGf:B DRAINS. ��=�4 <br /> S .RESP CITY STREETS CLSAN AT ALL TIMES. �aER 530.00 H <br /> 7 .ANY DAMAGH TO TH6 CURB AND SIDfiWALR WILL BS REPAI�D I 5110.� � <br /> TO THE SATISFACTION OF THS FUBLIC WORRS DEPT. 1171-5 5650.00 <br /> q000^c3817 O <br /> BLDG 8581.00 <br /> PLEG £65.00 � <br /> MECH 590.00 <br /> DFT.20 935.10 <br /> R SRCH 34.50 <br /> � DRVWV 820.00 <br /> � ACKNOWLED(!�Q�'CONDITIUNS <br /> �1 <br /> � The undersigned owner/appli�ereby a�r�cQO hold and save harm- <br /> "" less the City of Everett trort�By aj�d ayjQ�ijQQfor damages, costs. <br /> �1 �/�/� expenses. or causes of actiorif�tgnay � �:ause of inslallation <br /> � /� _(l ��1 G[��nn Z/ � /Ll�� and mainlenance ot the imprpu��nt or o t-ot•way use hereto <br /> c.c��. 6 i�..... N IF <br /> Approved for ConsLu tion Date applied for and lurlher agree�cS 4r�emo�ve�o��pon notice from the <br /> City d ro replace public prop��y damac,pwnb�by. <br /> ' � � "�` 1 � �� <br /> FINAL INSPECTION Date G ' <br /> Approved as Constructed Signature of Applicant ate � <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY ThIIS PER IT MUST BE STARTED WITHIN <br /> � 180 OAYS OF DATE PFR�v11T IS ISSUED AND THEREArTER IS TO <br /> 3200 Cedar Sireet ! <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:25C�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS i <br /> PROJECT OVEF 90 DAVS DURATION. <br /> . � <br /> � <br /> I <br /> f <br />