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Application For /� <br /> � PUBLIC WORKS PERMIT Date 3/26/96 _ <br /> �,�„ <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# _��/��� <br /> 3200 Cedar Sireet T-� . <br /> Everett,Wq 98201 259-8810 <br /> T�l POSTI Id G OCT 2 81996�uilding Permit# s,,,� <br /> TYPE OR PRINT ONLY Public Wo�ks Fee$ Z�� <br /> COUNTRYWOOD HOMES 14410 BEL—RED RD BELLEVUE 98G07 <br /> 649-8159 <br /> Owner Mailing Address Cit � . <br /> Y ZiP Phone � <br /> i <br /> , s��` <br /> '� ( .� ; <br /> Applicant Mai�ingAddress City Zip Phone <br /> Describe Proposed Work NEW HOUSE — BASIC 1179 <br /> W <br /> F- <br /> - <br /> PROJECTADDRESS(if known) 5431 25TH AVE W LOT 63 POWDERMILL DIV II � <br /> Atlach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: � <br /> •Property L1nes 'Outline and dimensions of all e;cisting and proposed structures on the lot •6cistfng and proposed utilities � <br /> •Centerline of street •Indicate North 'Show any proposed greding changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE p�/pq�96 2:� �p� ��k <br /> PERMIT CONDITIONS: � � <br /> 1.All calis for inspection shall be made 24 hours in advance-phone 259-8810. M00051216 <br /> 2. All work shall be pertormed in accordance with this permit and current City of�4il�tt D�i�Rp O <br /> Construction Standards and Specifications. p� Zi��� <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBE�tI-80p-4Ei,�GS, <br /> SRCtRG f4.5Q �'�' <br /> ORIVY't 520.00 � <br /> °� Keep city sheets clean at a!I times. M00008864 O <br /> �. CW�b �UlltC 811(J SI(ICWNfI(lll IIIC NI71� �ifC L'VW fi11ll UIIII:t(II�KC(I, ,wy il:miage 1������ <br /> discreGon of the Fublic Works L�spector. r �cP uccd al t(� � � <br /> 6 .�ry change in the driveway cut must be apprnved by the F'W tr�specror. �� ro ;��� <br /> existing apron width. ��� li`OO�I�Oited[o <br /> ? Adjust water boxes to gade at end of coustmction. �� �4�� <br /> $. Ddveways shall be completely cured beforc dtiving ou them. <br /> �� Rooftop drainage shall be discharged: <br /> • to the site's stortn dr�in sy,sicm (priv�te or public) <br /> • lo a rc�i(ICf1U3I f00f dUW115N0UL SYS�CfII (ICSI�'IIC(I�)CC SCCIIUII�I-9.� prII1C l'llY 5(J111Ill1�I5 <br /> • onto s�.iash blocks <br /> Che mCthod selectrA will be subjzct Io PubGc Works lnspcctor apProW,J. <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> L �� The undersigned ownedapplicant hereby agrees to hold and save harmless <br /> the City ot Everett from any and all claims tor damages,costc,expenses,or <br /> Approved for C tructi ,-� a�� causes of action that may arise because of Installation and maintenance of <br /> % the improvement or other right-of-way use hereto applled for��nd furthe�agrees <br /> to remove same upon notice from the City and to replar.e public property <br /> �� /G — ��� dama ed thereby. <br /> FI L INSPECT N Date � �- <br /> Approved as Constructed t i <br /> i <br /> Slgnature of Applican Date <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE AERMIT IS ISSUED ANU THEREAFfER�S TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAG�OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />