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Date�95 <br />qpplica�ion For <br />PUBLIC WORKS <br />Print or Type Only <br />Owner <br />Mike Mietzner <br />Describe Proposed Work <br />=� a z-z��4 <br />� TO POSTING _= <br />0 <br />t%: <br />P�RMIT <br />O p p p <br />If�00tn O� <br />N.-iQd OC'J <br />� o. ¢� .n r•, w <br />� � b � <br />� <br />� <br />:: <br />:� <br />�\lauiny •lndress � � � <br />oc�c�x <br />�i o 0 0:� c� r� �-+ a <br />316-0261 � ��4'�`�'�� <br />rn:,a�n:;ndd�e.5 ��t, <br />New house — Basic 1120 __ _ <br />Proiect Address lif known; � 3�� <br />/l' <br />v,,,��,����o,�=P�,m,,. ���`+�4� <br />. _�sr�� , <br />6icf9 Dept - <br />p,ibLc YJo�ks Fr.e 5 <br />,o��� F�� <br />�ess Aau� fee PmJ S /: <br />� g Ba4nceDuc $ �'� � <br />� � N <br />� a <br />98012 <br />� o�7i �c�i <br />H �o 3�yJ W <br />� S(n f�[=.l <br />Zip <br />Attach fourl4) coP�es ot Plans foi UroP�»ed wo:K � Dra�a� to;r,aL, ana nr.te �he'oticwmg as aDUlicable: <br />� Property Lines <br />• Outline and dimensions ol all ex�sting and <br />proposed strucW res on U�e lo� <br />• Existing and proposec utili�ies <br />� <br />1-0665 <br />Phonr. <br />Lot 26 Merril Crk 4 <br />• Cr.n�erilne of streel <br />• �ndical�i Norih <br />• Show any r.roposed 9rading chanycs <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be Ferformed in accordance with this permit and current City of Everelt Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424555 . <br />4. <br />5. <br />[� <br />7. <br />B. <br />9. <br />Fieep city ctreets clean at all timec. <br />Curb gutter and sideivslg in the plat are new and undamaged, any damege thereto <br />shall be replaced at the diecretion uf the Public Works In�ector. <br />Any chnnge in the drivetvay cut must be epproved by the Public Works lnepector, <br />width at prop line limited to eadating apron width <br />Adjuat tveter boxea to gzade at end of conatruction. <br />Deiveways e6all be completely cured bePore driving on them. <br />Rooftop drainage shall be discharged to the lots infiltration trench as per the <br />"Residential Roof Downspout System" detail nnd ae per the eiatng and location <br />informetion on the lot's site plan. Any chenge in the inliltration trench muat be <br />approved by the Pnblic Works Inspector. <br />Approved as Constructed <br />������ PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98207 <br />Phone:259-BB10 <br />N <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEPAENT OF CONDITIONS <br />7he undersiqned owneUapUlicant hereby agrees to hold and save harm- <br />---'—"—� I�ss the Giy of Everelt trom any and all Gaims for damages. costs. <br />exUenses. or wuses of action that may aris= because oi ins�allation <br />v LI Y �j �n�liec: I�or and luriherea9re sVto Qemove t am?I uP1on' nofcesfrom the <br />I aPP <br />pate � ��,;v and to replaca Public properiy damaged ihereby. <br />j -!1 -/�C <br />Date <br />5igna�we u� � ��• <br />90RD YS OF DAT�E PERMIT IS R UED AND THER AFTDR ISHTO <br />BE DII.IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />GANCELLtD BY THE CITY UPON ANY �TOPPAGE OF WORK ON THIS <br />PRO.IEGT OVER 90 DAYS DUFATION. <br />