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� <br />Date 12-1-94 <br />Application For <br />pUBLIC WORKS <br />Print or Type Only <br />�` I <br />Y " 34''�i'`f <br />.� <br />PE � I���ING �"�- <br />O p G. Q q <br />y O O O o I�fJ CJ � O <br />� r:vicio.�oo �r_', <br />u+ c� o .�. � «. c.� �'.� " <br />r.�� � N�MN p� _ M <br />Stefan Bolowich 2146 Clover Ct <br />Owner <br />Applicant <br />Describe Proposed lVork <br />Mailing Address <br />new house <br />Project Address �it known� 5123 <br />Ave W <br />� Ciry C�] 3 u �W1 <br />�O �U�C=j �-�a��F- <br />���������� <br />/ <br />Pu�Lc N, iMs Permll • q�j3Bq_ __- <br />eia9. oeo�� • 46349 __ <br />PuhlicWorksFee $ <br />Total Fee <br />Less Ao��. Fee Pa�a $ <br />Ou• $ � r <br />c, �:, � <br />[��r�, <br />.wcyr <br />p. N q <br />M <br />W � Phone <br />03u? W <br />����_ � <br />Zip Phone <br />� <br />Attach four (4) copies ol plans tor proposed work - Draw 10 scale and note !he following a� applicable: <br />• ProPerty Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centenine of siree: <br />• Indicate North <br />• Show any proposed grading changea <br />• Show measuiements <br />PERMIT CO� IDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Consiruction <br />Standards and Specificalions. <br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FHEE NUMDER 1-800•424•5555. <br />�I. h�stal! rnck consln�c�iou cuhaucr. beliind dnvewaV ns per c�ty stand.ud 82U8 a��d erosion conlrol as directed t <br />PuLlie \l��nk� L�speetor. <br />s. Kerp cil}� st�rets clemi nt all tiiues. <br />6. i:urb Uinter and ;idew�lk in �Le plet ue new and undam�eed. w�y d�wiugt il�ereto shall be replaczcl at d�e <br />disuotiou o( Ws Publi+:lVosl;s ��spcctor. <br />? Am� chrn�c in �he drit�ew:n� cut nmst br, approvcd �>y the F'V.� lnspector. wi!Ith at prop line limited in existin�: <br />aprou widtfi. <br />8. Adiust �vatcr box�s to g��dc :it end oF:onst�uclion. <br />�. I)nvrw;n�s sli,+ll be completeh� cured'nrloie. diiveov mi Ihrm. <br />IZ). I�uVIlV�) ll/iLLI1��,C �II:III �C tG�cli;�ged: <br />. to Ihe sitr'z- sroim draiu s��str,m fpii��,ite or pubiic) <br />. to a resictr.r.tial rooi dowuspout ,ti��ten� d�sieued pe� �ectioii •i �.4 oi tlie ciry st�mdnrds <br />� <br />� <br />O <br />a <br />. outo splash �locl:s q N�y�/ <br />���IC I11ft�101� SC�P.CtP.fl WI�� hC SIIhJCCt IO �'IIh�IC �Y01'�5 [)Ctt�llCtilBflf .ri��1�OV11fEDGEMENT OF CO�i01TIONS <br />� The undersigned owner/applicant hereby ayrees to holo and save harm- <br />— less the Cily of Everett Irom any and all claims for damages, costs, <br />---��� ' exPenses, or causes of action that maY arise because of installation <br />�j��� /�J /3 iL and m� int�nance ol �he improvement or other right-of-way use hereto <br />LCX/ �' T applied ior and funher agrees to remove same upon notice from the <br />Approved for Constructio Date Ciry u�id to;eplace public property damaged thereby. <br />n �/ � <br />�f�lr�l , ��— � —,/�� �/ <br />FINAL INSPECTION Date <br />Approved as Construcled <br />PUBLIC WORKS DEPARTMENT <br />3200 Gedar Straet <br />Everetl, WA 98201 <br />Phone:259-b810 <br />�o"c-c�t�9 GrC.e-cuLt�/ y/..� �—/3- � <br />Signatu of Applicant Date <br />VJORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />18U DhYS OF DATE PEAMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAY� DURATION. <br />