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� ,----�- <br />� � <br /> /�\� � <br /> �J APPlication For .��. -- <br /> PU6LIC WORKS�pERMIT oa�e 4/11/96 <br /> PUBLIC WORKS DEPAR'1�ENT Pi�blic Works Permit# < <br /> 3200 Cedar Street Q — <br />� Everett,WA 98201 25�810 <br />'� Building Permit p 5140R <br /> APR $ 11BW s 53 $ 853 � � 888 `.3 <br /> I � TYPEORPRINTONLY '� I� �'(�� ����j <br /> I � ` —� om ,y. yO7 2tl 1.9µ�Drks Fee b �}L� <br /> � NMN � � r+ M�00 <br /> � M M N <br /> ronnTxvunnn t;nr F� '" �" <br /> i - � vwner 1441(1 RFi g�p� RFr t vvn❑ qR007 649 A 1 5 <br />� Malling qddress `o`� �+ City SQ � i Phone � / <br /> i `�y k5 � {t�5� y1 � <br />�� . . APPllcant yQ �ffi� �� � � � ��i3 c�J' <br /> Mailing Address Cit <br /> Y ZiP Phone <br /> Describe Proposed Work_ NEW HOUS — BAS 11 4 <br />�� W <br /> H <br /> - <br /> !N '.w" ' � <br /> � }. i. <br /> �� ! PROJECTADDRESS(ifknown) _SgtS 75TH AVF S•� <br /> �- Attach tour(4)copies of p�ans for proposed work-Drew to sr,ale and note the following if applicable: � <br />. � . •Property Lines •Outline and dimonsions of all exisling and proposed structures on the lot •Existing and proposed utilities O <br /> � . � , •Centedine of street •Indicate North •Show any proposed grading changes •3how measuremenls <br />{ DO NOT WRITE BELOW THIS LINE � <br /> G PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-88i 0. <br />� 2.Ail work shall be perfarmed in accordance with this permit and current City of Everett Design and � <br />� Construction Standards and Specifications. <br />� 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � � <br /> �. Keep city streets cleari at ail fimes. � <br /> 5. Cu�b gulte;� u0d sldew;lik pl lhc Nl�t :�IC �Icw aud und:auaged, :uiy e�a�nage Uierclo s6:lII UC 1'C}Il�i�ed ai Ui O <br /> I discreGon ofthe PubGc lvorks Inspectcc /� <br /> 6. tUry change in Ihe drivew;ry cut umst be approved by the P W inspector, width at grop fine limited to ,i <br /> cxistu�g apron width. <br />( '. Adjust water hoxcs to grade at end of:onstniction. <br /> 8. llriveways shall be cornpletety cured before dtiving on ILem. <br /> 9. RooRop dr:w�age shal!be discharged: <br /> • to the site's storm drain rvstem (private or pnblicl <br /> • Io :1 fCSI(IC[IU{1I f00I (IOWIISE)OU( S)'SICIq (ICSI�'Il�(I E)Cf SCCIIOq�I-J.Q 0((jIC CIIY .I:utJ;vJs <br /> • onto splash blocks <br /> 1'he method selected wi� be subject to Public Works lnspecror approval. <br /> / �/J/ ACKNOWLEDGEMENT OF CONDITIONS <br /> ___��J� �c GI�.J�`--� ��`/ The undersigned owneNapplicant hereby agrees to hold and save harmless <br /> the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved tor Construc�on Date �� causes ot action that may arise because of installation and maintenance of <br /> / the improvement or other right-of-way use hereto applied lor and further agrees <br /> / to remove same upon notice from the City and to �eplace public property <br /> . L��L'-1�� �..:.---.- �� /J '�j` da a ed thereby. (� <br /> INAL INSPECTION Date ! � <br /> Approved as Constmcted � � � <br /> i � � <br /> Sign t f plican rl �/ Date <br /> WORK,-:JTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 160 DAYS OF DATE PERMIT IS ISSUED AND THE FTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />