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Date 1-1Z•�9S �: PuOLCWorkgPcrmltv ��_.. <br /> Application F4r,, <br /> T� ��ISTIN� �.�Z� "`�,rS 8,�, ;�o, . 46721 _ <br /> PIDBLIC WORK� PERMIT PVb7otalFeo�ec —�— — <br /> � <br /> O Less Appl.Feo PaiO � <br /> O <br /> Pfint or Type Only y $ � n � d � d o � � e�i���e o�� S_ �—_— <br /> o m �rati � o vi oair; i <br /> o ,-� m �u .-i «. r� o t� -u r: <br /> O � !4 •11 'b� � 6i � i1V +-i <br /> Select Eomes Inc 12811 8t �'Av��W Cverett 9�04 '�513-9006 <br /> c� <br /> Owner Mailing A �resso � '-� o, > „ Zip Phone <br /> � .+ � 3 O (y C�l CC W � <br /> h? � CJ C:1 S (J :S: G �1-� O LJ � U <br /> O Oc� G] fJp LJ � OI-� ('� 3. U) W <br /> \ U _1 J W � i c G_ p Q O W ' _ <br /> Owner CJ g Cil � = G� � O3C3SCUl U7 V <br /> Applican� Pdailing Address Citv Zio Phone � <br /> Describe ProposPd 4Nork 1 <br /> /�/ <br /> l <br /> — — <br /> _ '_ � <br /> ProiectAidressllknown� 5830 lOti� Dr W __ Lot 81 hferrill Crk Gardens � <br /> Atlach fo ir(4) copies o� plana for proposed work� Draw to scale and nete the folloviing as apUlicaule: � <br /> • Property Lines • Canterline of streel ♦� <br /> • Outline and dimensions of all existmci and • Intlicate North V� <br /> orcposed structures on the lot • Show any proposed gradin� chanyes <br /> • Existing and pr�posed utilities • Ehow measurements �/� <br /> ■ 1 � <br /> az�� \�i <br /> DO NOT WRITE BELON.' �HIS LINE o <br /> PERMIT CONDITIOI��!S <br /> 1.All calls(or inspection ehall be mace 2A hrs.in advance-phone 259-8810. ^ <br /> 2.All work shall b=pedormed in accordance with ihis permit and current City of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3.Call Lo at�on Underground ervicc�4�8 hrs.betore you dig.TOL!FREE NUMBEH 1-800•424•5555. � <br /> �1. �.,'."�l CIR� clreetc cfean at all (llTICG. <br /> i. �'mb gua�r;uid =idcw;Jk in tlie plat are new and uudatnaPed, arry da�naee ihcrcio shall hc repiaced ai ilte <br /> discretiou of tlie Pub�i: ��'nrLs Insprctor. � <br /> C, Any chanre in the dtive�v;ry c�[t nmst b� approvcd bV the Public \i/mlcs insrector, widlh al prop hne <br /> Wuilcd(u c,�siiupe ap�uu widlh. U�ieeway utay l:iper �radu;�ly to weel garig:; door euli;mce ilur an � <br /> appreved 3 car ear��e). <br /> -. ,�dju�t �=.nt�r 6oxee to cr�de at eud of constn�cbon. �/� <br /> �. Diic�:vay� shall Lc complcicls cwcd bcforc dritiv�g ou tl�cm. \�� <br /> 9 hootiep drainaee sh�ll be disch�rred;o ihe lots in6lhation hrnch as p:r Ihr. "Res�deut�� �oor'noti����,���c � <br /> ti��[�m° detail jartacheJl arid �, {.r C�c sizine v�d locaiiou inio�mation on dic IoPs site pl�m. A <br /> �reousiniclion iu��(iug tuu;t L: ;cheduled �F•ill� Alla�i LocL•e (3SS-9655 mob. m 259 SS1�1 o1Tee) prior to ' a <br /> mslall;ifion o(thn inliltration svsirm h�rv chan�e in ihe in�ilhation trench must be approved b}'tlie Fublic <br /> 'd:'�ni.s Iiupcclui. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicaN hereby agrees to hold and save harm� <br /> less the City of Everett irem any and all claims for damanas. costs, <br /> 66n�1 I_ expenses, or causes of ac'�on that may arise because of rstallation <br /> —��I yl Cy,/� �l/ /y� and maintenance of the improvemeni or other :ignt-ef-way use hereto <br /> � � � � applied fr,r znd further agrees lo remove same upon rolice from the <br /> !•pt�roved for Construction t� Date City and to replace pu6lic pro rty damaged lhereb^ <br /> 7 � <br /> r � _, / <br /> 7 <br /> ��.--•� — i - a 6 _ ,i � � � <br /> fIIU:L Ir!'>Pr�710N Datc �� �� <br /> h�,;;,o,�;rf ;,�, Cr,nslrur,led SignaWre of A icant Date <br /> � i PU�LICVlOfiKSD[PARTM[NT WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �,y � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � ��+, �� ,� •;200 raAm Slreet BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY OE <br /> �� ��'qf61t�N��^`'j7j''�>> CANCELLED 81'THE GTY UPON ANY STOPPAGE OF WORK ON TFiIS <br /> h�.�,���:�.2,'rHNu� PROJECT OVER 90 DAYS DURATION. <br /> �... _. . .— ._ _ — _ �..�.ny� <br />