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Date 4-21-95 <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />John Urban PO Box 6661 L <br />Ownei <br />Owner <br />qpplicant <br />Describe Propos�d Work <br />TO POSTING -« I P��������.��,�=P�,m��, qs-�2_v_z� <br />6inn oen� • �BL�lfi <br />PEt3MIT <br />CC <br />1= 1 <br />fl <br />�;���,� � <br />`' w in ci r.i ..� o <br />r�a �r, n iv ., w c.; <br />�_ .. -, .n :n n� <br />�r• <br />mwood,98096 771-5729 <br />\laiiin�,; �cu�css � - .+ <br />c� � <br />� n <br />0 <br />rn.,a,.,;; Address <br />new house __ ________ <br />Project Addrass (if known; .2419 SStll_St SW ___ _ <br />Pu1�M1c 1Ymw5 �ce 5 <br />iolil FNe <br />less A401 Fee Pa�.] S <br />� �� Cg.,�¢�,� o��� <br />T— <br />�o c� � ir; <br />ln «1 .�: : <br />ti � <br />�' � � ; �._ =�s o rr <br />�n � 's_� "�o �- � c� Li <br />c�`�:, �n� �-:nr <br />I 1 W,i (y_ f• pCL' <br />4� �_ �: r:� �n o x_t <br />C:di <br />s 20' <br />"l,�e i� `= Phau� <br />1i.� Gl r._i <br />3 U7 W <br />�n� 7n � <br />Zip Phone <br />Attaeh four (4) coP�^s of Plans fo� proposed wo:� � Dr�e: to .c,il,..u,n neie th��'onc:ving as anplioabie. <br />• Pronerry Lines • Centerhnn n} SVee� <br />• Outline and dimensions ol all exi5hnq an�f • I��,tl�wb: Norih <br />proposed strucWBs on ihe toi • S�iow any r.ropused �rad�nq cnan��-5 <br />• Existing and proposed utilities • Shnw measurements <br />S LINE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 lirs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current Ciry ot Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location UndSrground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4. Kcep city streets clean at all times. <br />5. Cmb ;uttzr and sidewalk u� U�e plat uz nzw �uid undamagzd, any d,unage Uiereto �hall be replaced at U�e <br />discretiori ofthe PubGc Works Inspector. <br />6. MV change ui the driveway cut must be approved by the PW Tnspector, width at prop line lunited ta <br />c�asting apron widlh. <br />7. Adjust water boxes to e,rade at end of conxin�cfio.^.. <br />&. llrivcways shall be completety curzd be;ura dri�vig ou �hem. <br />9. Rooftop drainage sh�ll be dischar;eA: <br />• to the site's stonn drain system (private or pubGc) <br />to a residential roof downspout .ry:tem desipied per section �t-9.4 af the ciry standards <br />• onto splash blocks <br />The method salected will be sub�cct to Fublic Works llepaitement approv;J. <br />� <br />qpproved as Consiructed <br />�A`I�PUBLIC WORKS DEPARTMENT <br />32G0 Cedar Street <br />EveretL WA 98201 <br />Phone: 259•8810 <br />��i <br />N' <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDG[ME�IT Of CONDITIONS <br />ihe undr-rvr;,ned owneuapPhCant hereby agrees to hold and s�ce hann� <br />"�i i�ass thc Cdy ot Everetl from any antl aii claims for tlamage:,. costs. <br />�� espenses. o� causes ol action that may arise because of instaltation <br />�� qi�;j �ndinten2nf,E' n! II1C 1i11prOvemenl or o�her rifjhl�o�-Wa'/ USP. hHrP.�O <br />I�ppi�n;; f�r and further agrees lo remove same upen notice tram the <br />I C�!c �r.d to repiace G��Uhc pronerry damaged fhereby. <br />_____�r�.T������ <br />Signr:, we of Ar�plican! Date <br />11�OP.K AUiHORIZED BY THIS PERMIT MUST BE STAR�ED WITHIN <br />190 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />�iE nILIGENTLI' f'URSUED TO COMPLETION. THIS PERMIT MAY BE <br />G4NCELlED B'f TFIE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />FROJECT OVER 90 DAYS DURATION. <br />