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3/�r 9s 95 i 15 � <br /> Date (� � C�, PuObc Works Po�mn a _1 <br /> Application For � � �°'��I�� � ' U a�ae occ� .47663 <br /> PUBLIC V��ORK� PERMIT PubioteFeeFee S = <br /> a <br /> <-� lnss NoOL Fec Pai[ 5 <br /> Print or Type Only n o -�� c� r� o c, „ ce r, �, e,�a�oco�� s 20� <br /> G O f_'i p VJ ['.i rl C] r� h i <br /> aT <br /> OJ L� O C eF Ci O O i� Q. <br /> - G I�� OJ ' "i. 4..1 t�) C- O �'� <br /> 'y .� :b, �R +f# _- ..� ., ,.J :fl <br /> O aA +1: .s? �� <br /> Select Homes inc 12811 8th A�e C; A-201 EvL�'etL' 98204 513-9006 <br /> Owner Mailing p dreSs� r� -�- �31y � �7 Zip Phone <br /> \ d- Cw_ 3 O :r Ni :i 1+J �• <br /> `u O C9 C9 S C] ], 5 O IL O 111 O C] <br /> —� O ['1u:iLt Of� N 01— CJ3 Ul I�� <br /> � o _� _iw _� �err: n ¢ ow = �: <br /> �^• sc r,:� n. x_� r„ u� r_ a 3 st u� u� �� <br /> Applicant Mailinc�A dress City Zip Phone -�--�- <br /> f _l, <br /> Neco house — Basi.c 101 (Alder/4Leve1) \V , <br /> � <br /> Describe Proposed Work �� I�� <br /> — J <br /> Project Addiess(il known� _ 5632 i0th Dr W Lot 16, Merrill Crk Gardens � <br />� Attach four(4�copies of plans tor proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Cenlerline o(sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading rhang2s <br /> • Existing and proposed utililies O Show meaaurements � <br />' DO NOT WRITE BELOW'HIS LINE <br /> PERMIT CONDITIONS �� <br /> 1.All calis for inspection shall he made 24 hrs.in advance-phone 259•8810. � <br /> 2.� 'I work shall be pedormed in accordance w;th ihis permit and wrrent City of Everett Design and Construction <br /> Slandards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUM9ER 1-800•424-5555. � <br /> � �1. 1.�ep cily sireeis daon a1 all times. <br /> 5. Curb uutter and sidewalk in ihe plat �re new and unc7�maned, any damaye � <br />' theretn shall be replaced ai ihe cliscretion of the Public Works Inspecior. <br /> L. Any r,hnnye in ihe driveway cut musi be approvcci by the Fubiic Works Inspector, � <br /> width at prop line lirniteci 10 existin,y apron width. Driveway may taper c�raduully f <br /> moc:i gaioc�e door entrance ((or an approved 3 c.�r garagej. /_ <br /> 7. F�djust wotai Goxr-•, io c�rade ot end o( consiruclion. V� <br /> 8. Driveways shall be com��lelr:ly cureci before drivinc� on them. O <br /> 9. Roc'top ��roinaye shall Ge dischorc�ed to ihe lots infiltraiion trench as per ihe <br /> "Re ��)r:��lial Roo( Downspout Syctem" detail (n1lar.hr,ciJ and os per Ihe si�in� ancl � <br /> localion in(ormaiion on ihe IoYs site pian. A preconsiruc+ian meutinc� mu;t L-e <br /> scheduled with Alan I ocke (388-9b55 mot�. or 259-8810 offire) prior to instnll�tion o( <br /> the infilirafion system. Any chanc7e in the inliltration trench mu;t be approved Ly <br /> ihe Publir_ Works Inspector. <br /> ACKNOWLEDGEN.�NT OF CONDITIONS <br /> �i he undersigned owneriappl,cant nereby agrees to hold and save harm� <br /> less ihe Gry ol Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> y�� 3�,s�ys and maintenance ol ihe improvemeat or other right�ohway use hnreto <br /> Appruved for Cyopstruction Date applied (or and further agrees to remove same upon notice f�om ihe <br /> ,/ � City and to reolace public property damage6 thereby. <br /> _���- ���- s� ���- N�� .� 3/�lys <br /> FINAL INSPECTION Dote .U"'�.�� <br /> p,pproved as Constructed Signature ol ApPlicant Date <br /> �� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS P[RMfI MUST BE STARTED 'vVITHIN <br /> 3200Cedar3treet 180 DAYS OF DATE PERMIT IS ISSUGD AN� THEREAFTER IS TO <br /> EverelL WA99207 BE DILIGENTLY PURSUED TO COMPLETIOP7. iHIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY i TOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />