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I�_. <br />� <br /> ���:,-.., , . .. _ <br />� <br />' <br /> P�bLt YlO�FS PC�mil� ('� CxJ� � <br /> �r� B�pg OeO��• � - <br /> y�H Date_12�z8��2 39097 <br /> � Application For <br /> ��x PUBLIC WORK� PERMIT P°°to�a'�`«�.F" 5 <br /> H <br /> ayv� <br /> rl � le.sAoo� RCPnm � <br /> � ��%• <br /> y �,,,� Bmm�cc D�c S <br /> `� y� Print or Type Only <br /> 'GsJ H'TJ <br /> V�H 644-2323 <br /> x O� Country�vood Homes 1441G Bel-Red Rd. k200 Bellevue, 67A 98007 p��one <br /> t�� y d Owner Mailinq Acdress City Zip <br /> OH�y <br /> � �p Cwner -- ---�--- <br /> 4�� O Mailin,Adtlress Gty Zip Phone � <br /> z H C• APPlic�nt ��. <br /> t9" y'Y» -- — <br /> H H Describe Proposed Work New SFR (Sasic 265B) <br /> N <br /> g �y _ <br /> � �y /LeT��__ — W <br /> H O�n � <br /> � � - Project Adtlress lif known) SRZI – �Sth Avr 9f �Y -------�--- , <br /> � <br /> Attach tour I41 eoples o� Plans 1or proposed v:o�k- Drav: m scale and note the to lo:,ii�7 as aaahca6le�. � <br /> � • Property Llnes • C�•�Ierhne oi snae� , <br /> • Oinlinc and dlmensions o�all exishng nrd <br /> • Intlicate r:arih <br /> proposetl sirucP�res on the Ict • ihow any proU�sed yrad�n<j ch�nyes <br /> �.;.�,.,, O Show�ne:�surement5 � <br /> • ExiS�iny dnA prOpoSed u�ih�ir,5 <br /> ��� DO NOT l7RITF BE10�5 iHIS�iNE � <br /> PEfiM1T CON�ITIONS � <br /> 1.All catls ier inspection shall be made 2:hrs.in advanr,e�nhens?.59•8810 <br /> '�� 2.All work shall be pedermed in accordance with this pu��ml and c�rrenl City o'Everett Gesiyn and Construction <br /> �� Standards and Speci6callons. � <br /> 3.Call Location Underground Service�6 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> 4_ Install rock construction entrance behind driveway as per city <br /> �� standard ti`L08 and eroaion contro] a3 directed by Publir 'n�orks O <br /> 's Inapector. <br /> 5. Keep city streeta clean at all times � <br /> 6. �rb �itter and sideNa]K in the plat are neu and undamaFrcl, <br /> � '�� any damage therato shal] be replaced at the discretior, of tl.e � <br /> Psbi.ic Works In:spector. <br /> 7. My change in the driveway cut muat be approved by the Yv7 I1- O <br /> �� spector, widt.l� at prop line limited to exiatin!'- apron cridth. <br /> �w' � 8_ Connect �77 ronf, yard and dri�eway drains to stor� drain � <br /> s,Yatem provided tn lot. <br /> 9. Ad,iust water hoxea to grade at end of construction. <br /> ��' � 10. Driveways shall be completel.y curad befor� driving on then. <br /> . . ACKNOWLED�[PAFNT OF COIdDRIONS <br /> -- --- �C11� _ —_ 7he und��i_iqnetl owner,'apphcanl he�eby aprecs to hold and save harm- <br /> V — Iess tl�.0 Cily ot Everetl Irom any anA al, claims lor dama9es, cosis. <br /> /� I expens•�:. or causas ol ac�ion that ma; arise hr.cause of inslallaiion <br /> � / / n ❑�id ma��n�enance ol the unprovement or olher nght�obway use hereto <br /> –'�r(1 1-�� l/y���–(��L� I—�–.Lf � — apfdied I r ,ind fur�her a9rees to re �e saine uPon n0�ice trom �he <br /> Approvetl for Consiruction . Da1e �,t md t r�Pl�ce P��f�lic property i.�na�ed thereby. <br /> �� / � <br /> ���/��("z_�-_ S�-_ / 3'3 IV\c� <br /> FINAL INSP[fTION �`'�� – Date <br /> qpprovetl ns Consiructed <br /> S�gnatwe nl Applicant <br /> WORK AUTHORIZED BY HIS PERMIT fdUST B[ STARTED WITHIN <br /> �� PUBLIC WORKS DEPARTMENT 180 DAYS OF DAT[ PERMIT IS ISSUCD AND THEREAFTER IS TO <br /> ,r�Z�� 3200CedarSlreel I3E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt.WA98201 CANCELLED 9'I7hIE CITY UPGN ANY STOPPAGfl OF WORK ON THIS <br /> Phone:259�8810 i PFOJ[CT OVER 00 DAYS DUf7ATION. <br />