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� APPlication For � � �� <br /> PUBLIC WORKS PERMIT �a�e 3—�s_56 %� � <br /> PUBLIC WORKS DEPqRTMENT <br /> 3200 Cedar Street Public Works Perrttlt fl 3 <br /> Everett,WA 98201 259-8810 -- <br /> TYPE OR PRINT ONLY <br /> �!� POSTING OCT_ 2 8�c g Buildingpermitff 5123_�_ <br /> Public Works Fee$ �.(�� <br /> Countrywood Homea 14410 Bel-Red Rd Bellevue 98007 649-8159 <br /> Owner Mailing qddress <br /> City Zip Phone <br /> Applicant Mailing Address (� <br /> City Zip Phone <br /> Describe Proposed Work new house <br /> - W <br /> N <br /> '-/� <br /> PROJECTADDRESS (if known) 5422 25th Ave W /pq 6 `q� yJ <br /> Lot 58 Powde�Mi Hi?grtPan� 1 #k'k:k <br /> Attacn four(q)copies of plans for proposed work•Draw to scale and note the tollowing if applicable: m <br /> 'ProPertY Lines 'putline and dimensions of all existing and proposed structures on the lot •Existin and ro���p�5� 1235t1�.� <br /> 'Cenierline of stree; •Indicate NoAh •Show aiiy proposed grading changes •Show measu ments �.tl13 utilitiBS O <br /> sii2.ao <br /> DO NOT WRITE BELOW THIS LINE � ��� � <br /> PERMIT CONDITIONS: <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. PLH p� ��� Z <br /> . . 2. All work shall be performed in accordance with this permit and current Ci of E ��� <br /> , Construction Standards and Specifications. � ��9�and O <br /> ; 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMB�� s105,pp <br /> �424-5555. � <br /> � f70.00 <br /> a Keep city streets de�n at all fimcs. �v �'� � <br /> S. CW�II V�UItC!811(I SIdCW3IIi Ill LIIC(1I8I 8fC fICW�1U(I lWfI8111'd�'C(I, airy Jamago Uie�ret�o`shall b�oP�ad at Ui O <br /> discretiou ofthe Public Works Inspector. <br /> 6 A�rv char�ge in the driveway cut must be approved b}�the P W lnspector, wid[h at prop line limited to � <br /> existing apron width. <br /> � Adp�st water boxes to �ade at end of constnicfion. <br /> 8• llrn'oways shall be completely c�ued betbre drivmg on them. <br /> �• Rooftop Jrainage shall be discharged: <br /> ' to the site'S stotm drain systerri (private or pubfic) <br /> : to a resiJential roof Jowuspout system designed per sccliou d-9.�1 uf Ihc city s�auda�Js <br /> onto splash blccks <br /> 7'hc method setecrod wi11 be subjcrt lo Pub6c Works Inspector approval, <br /> C� The undersigned owner/oap�cD.�Eh Eeby�9fe ONDlho�ld nd save harmless <br /> ` ' the City o�EvereM from any and all claims for damages,costs,expenses,or <br /> proved for Co s ction causes of action that may arise because of installation and maintenance of <br /> Date <br /> /� , theimprovementorotherrighFof•wayuseheretoappliedforandturtheragrees <br /> to remove same upon notice from the City and to replace public property <br /> FI N9 '�ON �G �� dam ed thereby. <br /> Approved as Constructed Date <br /> Signature of Applicant ---�----I-� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSU DaTO <br /> COMPLETION.THIS PERMIT MqY BE CANCELLED BY THE CITY UPON ANY STOPPqGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />