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Date�2 r„n�,�,•�o�ks Po,m��. _�_! ' —� ;- <br /> sinv o�o�.� 36419 _ <br /> Application For <br /> y�H PUBLIC WORI�S PERMIT "°°';o`"°'�e�e` � — ; <br /> �i�'" <br /> LrssApO�-�+!r,PO�:t S <br /> '�y eaiancc nue S ��—� <br /> C��x-+ Print or Type Only � <br /> �x� rn nncr���r sa,-y� <br /> H A��, <br /> K y� Countrywood Nomes 14410 Bel-Red Rd. 11200 Bellevue 98U07 644-2323 <br /> . � H� �����E.� Mailing Address City Zip Phone <br /> y y�-~+ Angie Steveiis! � � <br /> x�, Owne r <br /> � �� Aoplicant Mailing ',-Wrrss Ciry Zip Phone � �J �I <br /> � <br /> new house \ <br /> ��� Describe Proposed Work � — <br /> H C, <br /> 7 y3 <br /> � z <br /> H H � L61 <br /> y <br /> H <br /> n b� 5916 25th Ave�jv': Lot 21 � <br /> _C�' C� P�oject �.ddress lil known) . - — <br /> 3, [s1 <br /> s Attach lour(4)c�p�es ol plans for pwposetl wo�k- Draw to scale and note the followin,es app .ca61e: � <br /> z y cn � <br /> H O(A • Property Lines • Centedine ol stree� : <br /> • Outline and dimensions ol all existing and • Indicate N;�ii. .- - <br /> proposed structarec on the lol • Shm�any ProposcJ,radiny cnanges <br /> � • Ex��sting and propasef. utilities • Show measurements � M <br /> W <br /> �� DO NOi WPITE BELO�J THIS LINE � - <br /> �� PERMIT CONDITIONS � <br /> �� , t.All ealls lor inspection shall b�made 24 hrs.in ativance�nhonc 259•8810. . � <br /> l�� 2.All work sha�i be pertormed in accordance witl�.;nis permil and cuvent Ciiy of Everett Drs; c,i Construction <br /> ` Standards and Specifications. - <br /> 3.Call Location Undergmund Service 4B hrs.belore you di9.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��� . �� t.ril l 1 rl c;,:i �.rn��r.ipn : nir:inr t.� i�.�.�f ( , <.;�� ar 1'.. .� .. . � <br /> � t, f�dar�n ft �I.r> :�n 3 crnsipr� r qnt,r��l � <',ir•n� t. .rl �.�; h'��bl i . Idni 1..�. . . <br /> Tnal�r:t�n. - � <br /> � . Keep city sttreets cletin �t a]i t,imes .. - � <br /> ���' c•. Cnrb rutter cnd sidr.Nalk in the plat �n•e neW and utu3ama�ed. <br /> �� ;.ny damaeF +heretrr shal] be replaced n'. the discretion of + I�� � <br /> F��hllr. IVnrke InFpr:riv�r. <br /> �'�' Any chanee in th� �'ri��ew�ay r.Ut must be repFraved hv }hF PW iri �fy <br /> 3per.tor. Nidth %i1 �rop li.ne ] imiteJ to existin�� �p n Gii,!�h v <br /> �,. C��nneei: :31] rnnf ���rd and dr•ivewey drains to st�nr fi -�V�� � <br /> 9vstFm vrovider cr ]nt.. <br /> '�� ?. Ad.ivat, water h��v.r:� to er�de at end of r.on,t.ruction <br /> �`� 7'�. (.�ri•,PWivr, -h:i11 bF� ����mplr-,ta)v currd be£ore r3rivinh - r, rl�,�c�. <br /> ACKNOWLEDGEIdENi OF CONDITIONS <br /> _r � 1��� —`— Thn undrr,igned ownedapplicanl herehy agrees to hold and save harm- <br /> ' less the� City of [vurett ��om a^� and all claims for dama9es, costs, <br /> axpensos. or causes o� action ��,inl iaay anse beca�se o`. mstallation <br /> � � �C � � �/_ Lj�7 and maiNenance ol �he nnprovemen� or othcr right�of�way usc hereto <br /> - t"etx•� �C�-L, --' t �� anni�ed io� and Iw�her aqrees lo rert nve same cpon noiice Irom �he <br /> Approved lor Cunstruction Date ���y;�nd to replace UuUi�c property dar iaged the�eby. <br /> �X� -- ' "�� '' -- ';rl' , ���, �'jz— <br /> PINAL I� SPEC�ION Date ' -�,�.�— <br /> qpproved as Constructed S9naturt�f Annlicant � Da�e <br /> WORK AUTHORIlED BY THIS PER'11T MUST dE STARTED WITHIN � <br /> �� �°UBUf,WORKS DEPAFTMENT 180 DAYS OF DATE P[RMIT IS ISSU�:D AIJD THEREAFTER IF TO <br /> _, 8200CedarSireet BE DILIG[WTLY PURSUED TO COMPLELON. THIS PERMIT MAY BE <br /> Iivere�C WA 98201 CANCELLED 6Y TH�CITY UPON ANY STOPPAGE OF 1h'ORK ON THIS <br /> Phone�259�8010 PHOJECT OVER 90 DAYS DUR�TION. <br />