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M <br /> I <br /> i <br /> 17 2os _�_ <br /> �� • APPliwtion For , . <br /> � PUBLI�: WQRKS PERMIT Date 3/18/97 <br /> � <br /> PUBLIC WORKS DEPARTMENT Public Works Permit q � O� <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 <br /> � Building Permit k�„I,S�3 <br /> TYPE OR PRINT ONLY �� i�� Nr MOV 1 S 199� <br /> - R"'a�I"" — PublicWorksFee$__ZD <br /> L &L VFNT�JRES _ 10711 FVFRRRFFN taev FVFRFTT qR7f14 99(1 1Rig . <br /> Owner Mailing Address City Zip Phone . <br /> LARRY POND 290-1818 <br /> . ApplicaM Mailing Address Cdy Zip Phone <br /> Cescribe Proposed Work NEW HOUSE - BASI 12 � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) � �1 � �C� � <br /> � Attach four(4)copies of plans for proposed work-Orew to scale and note the following if applicab�e: � <br /> � , •Property Lines 'putline and dimensions of all existing and pmposed structures on the lot •Existing and proposed utilities O <br /> •Centerline of street •Indicate NoKh •Show any proposed grading changes •Show measurementc <br /> ! UO NOT WRITE BELOW THIS LINE . �k <br /> ` PERMIT CONDITIONS: / I � <br /> a� 1. All call^for inspection shall be r�iade 21 hours in advance- phone 259-8810. �� <br /> � 2.All work shall be performEd i��accordance�vith this permit and current City ot�!t Des�nQp <br /> ' Construction Standards and Specifications. PL9C 370.00 � <br /> 3. Call Locatio� Undergrour.d Service 48 hrs. before you dig. TOLL FREE ilUM��I-800-�5. � <br /> SRCFR�3 54.50 P"' <br /> DRPiW4 f20.00 ♦^ <br /> NCiU009331 r�/ <br /> 4 .=1a p�r�,ublic v,orks apprcrved site plan. �� ��.� O <br /> �. Install w intiltratio�� trench buili as per Section 3-2.ti.2 and i�iqvre and 1'a�p$;jy�of tt�e city <br /> �lo"mvater,bia��agement�tvwsil (copy's staple�l to lliis pennit). 11ie infn�6�n 4aR8@a�fAl( b� no a <br /> closer thmi 5 teet lo m�,up stope property ;itie or fbimdation nor closer t}�t`�'i�4�{ecf��oumslo . <br /> nroperty= line or tound�tion Call Pub!ic Works tor�n in4p�ction prior to��ting�r �i�5:.. <br /> ��� <br /> /��„ <br /> ACKNOWLEDGEMENT UF CONDITIONS <br /> �J/� �/ A . The undersigned owrer/aaplicant hereby ag1ees to hold and s�ve harmless <br /> /��( �J ���� the City ot Everett from any and all claims for damages,costs,expenses,or <br /> A roved for nstruction Date causes of action that may arise because of installation and maintenance of <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> � � to remova same upon notice (rom the City and to replace public property � <br /> , ` S—y—5'� damaged thereby. <br /> FINAL INSPECTION Date � <br /> Approved as Constructed <br /> . <br /> ature of Applican ��� Date <br /> WGRK AUTHORIZED BY THIS PERMIT MUST BE SiARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI;.PR0.IECT OVER 90 DAYS DURATION. <br />