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� �Plication Far <br /> PUBLIC WORKS PERMIT Date 2/13/96 <br /> �> ,c <br /> PUBLIC 1�ORKS DEPARTMENT Public Works Permit H _ ��/v� <br /> 32�0 Cedar Street <br /> Everett,N�q98201 259-8810 <br /> oJ, Building Permit N�pgbb_—_ — <br /> onc., , c � a o p � ^ <br /> TYPE OR PRINT ONLY x= in r� o �.i a in n 8 c� � c. <br /> °- Public , rkr Fee$ � <br /> �n �d lfl U) U'1 G �-'' Ca 1f] O G� . � <br />� vi � o n n m �� rv�i n r-� c� � �y <br /> N 1{� ,'� IR H� b� Hi � V (.i � ��\ 1 <br /> Countrywood Homes 144�10 �it-Red' Rd Pell�ue 98007 649-8159 , �� <br /> Owner Mailing Addre� �, p r�Qjty m o > Zip Phone 1 d/ <br />� � U] G. G' fs: 3 O ci h: O_ lal X \�� <br /> p� C? GO W LLl Ln �- 1' _r Ci Uj O W G1 [,7 <br /> (^l O Clf•- F- [Ii [� L7 �' CJF- p3U7 W <br /> � .Ynt' til � � tl �� u �i � � � [� In �i <br /> Applicant Mailing qddres City Zip Phone <br /> I <br />�"'°'"' "'�"* Describe Proposec '";�rk New house - Basic 1158 <br /> W <br />'� H <br /> - <br /> PROJECT ADDRESS(if known) 5526 25th Ave W � � � S t �IV Z- � <br /> o �I� � 5 ' - Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: <br /> , 4 O <br />` + •PropeAy Lines •Outline and dimensions of all existing and pmposed structures or•he lot •Existlng and proposed utilities <br /> I , �� �� , •Centerline ot street •Indicate NoAh •Show any proposed grading changes •Show measurements � <br />; DO NOT WRITE BELOW THIS LINE <br />� PERMIT CONDITIONS: � <br /> 1. All calis for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> F 2 Atl work shall be performed in accordance with this permit and current City of Everett Design and <br /> i Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dia. TOLL FREE NUMBER 1-800-424-5555. � <br /> i <br />, 4. Keep city streets clean a[al! fimes. � <br /> 5. Cwb gulter and sidewalk in tlie plat ue new a��d undamaged, :ury damagc tl�ereto shall be roplaced at th O <br /> discrelion of the PnbGc Works fnspector. a <br /> I G. Airv chan;e in the driveway cut must bz approved by the P\V Inspector, widih at prop line limitad to <br /> existing apron width. <br /> ?. Adjust watcr boxes fo gradc at end of constnictiou. <br />� 3. lltiveways shall be completely cured before dtiving nn them. <br /> 9. RooRop drau�age sh�ll be discharged: <br /> • to the sitc's stomi drain sys te or pubtic) <br /> • to a resider 'al roof down�poul�sys m designed per secdon 4•9.4 of the city stanJ.�rds <br /> • onto splas b e � � <br /> 'Phe method s�ec ed�e subjec ' ��p�ement appr val. <br /> �'� � P;�a�° �� 9lv�r/ <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> ��[,(���C� �/�3/� the City of Everett from any and all claims for damages,costs,expenses,or <br />� Approvad for Construction �Date causes of action that may arise because oi installation and maintenance ot <br /> the inprovement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice from the City and to replace public property <br /> damaged thereby. <br />� FINAL INSPECTION Date <br />� Approved as Constructed � <br /> e?a? �`1(0 <br />� i9nature of plican� Date <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST 8E STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED ND THEREAFfEH IS TO BE DILIGENTLY PURSUED TO <br /> COPAPLET�ON.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />