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D � -Z84 <br /> � APPlication For —_ <br /> PUBLIC WORKS PERMIT Date 4/30/96 <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# _`�/I f ' <br /> 3200 Cedar 5treet <br /> Everetl,Wq g8207 259-8810 <br /> P s .mp BuildingPermitR S15R1 <br /> NPEORPRINTONLY 6 ? 6'�C}�jI1��7 N�_---2----' publicWorksFae$_ <br /> Countrywo,d Homes 14410 Bel Red Rd Bellevue 98007 649-8159 <br /> Owner Mailing Address Cit <br /> Y Z�P Phone <br /> � ' <br /> Applicant Mailing Address Cit � <br /> Y Z�P Phone <br /> Describe Proposed Work __ New house — Basic 1179 <br /> W <br /> F- <br /> - <br /> PROJECTADDRESS(ifknown) _ 54�0 25th AvP [•� ���`��96 1:31PM OOORN574 ��.� <br /> Attach tour(4)copies of plans for proposed work-�raw to scale and note the follo�ving if applicable: T �0051581 � <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the lot "Existing and p�DG d utilis1O9��� O . <br /> •Centerline of street •Indicate North •Show any proposed grading chianges •Show measurements� �g05�,� <br /> F�CH �.00 � <br /> DO NOT 1A�'RITE BELOW THIS LINE ��1 �,�.� <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. �'� 1rt5 <br /> 2.All work shall be pertormed in accordance with this permit and current City of��59�1'�rQB O <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM�800:4Zq=�55, � <br /> sew <br /> CHECY, �C"077.00 �/� <br /> -�� KCCP CI(Y S(TCC15 L'Iean at all 4mes. ��J <br /> �. Curb gullrr :u1ll 51(ICW:III(III lI1C !)I8l ;11"C pCW :ill(I lW(IWII:IE!CfI, :ury clamage tli�retu sh:Jl bc replaced at th O <br /> discretion ol'C e FubGc \vorks Inspcctor. /� <br /> F Airv chanee ir. the ciriveway cut must be approved hy Ihe PW tnspector, width at prop line limi[ed to �i <br /> custa�b �pron width. <br /> '. Adjust water boxes ro gradr• at end of constmc6on. <br /> s- Uriveways shall be completcly cured bzl'ore driving on them. <br /> '�. Rooflop Jrau�agc shall be discharged: <br /> • to the site's srom� drain systcm (priratc or public) <br /> ' 10 �IZSIfICIlI18I 1�UOI /I01ti11s�0UI SySlClll (ICSI�ItC(I�)CI'SCC(lUL d•9.d ot'lhr city sl�u�d;u�ds <br /> • onto splash blocks <br /> i'he method selected will be xubject ro PnbGe Works Lispector,ipprov:il. <br /> y'`� , <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �//��G�/ _ �/�� The undersigned ownedapplicant hereby agrees to hold and save harmless <br /> �� �f` �j the City of Everett from any and all claims for damages,costs,expenses,or <br /> . Approved for CQnstruction Date causes of action that may anse because of installation and maintenance of <br /> > '� the improvement or other right-of-way use he2to applied for and tudher agrees <br /> i"� �`��� / / to remove e upon ice from the City and to replace public property <br /> .,-'CCrI-'c.-/� : � j/-/rf-jL damaged eby. / <br /> FINAL INSPECTION � Date � <br /> Approved as Constructed n � <br /> � �% �d �9-� <br /> Signature of Applican Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PUASUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLE�BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PflOJECT OVER 90 DAYS DURATION. <br />