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.'Sd�7r7 <br /> / <br /> Pu�Lc Woiks Porm��t� —��� <br /> Date 1�"�90 y0J"L3t> 0 � <br /> om9.oeo�..---- -------- <br /> Applir.alion For _ _____ <br /> P� �/` B.a6.��/ �YY�R�� r_ ��l�Y� �T P,ioitoi�re��e� S-- <br /> I.essapo� r:�,vno 5 <br /> Balance D��e <br /> S %cx% <br /> Print or Type Only <br /> Select Homes, Inc. P.O. I3ox 708 I4ukilteo, 47A 982%5 827-8.196 — <br /> - '-' Mailing Address City Zip Fhone <br /> Owner <br /> Same <br /> Applitac; <br /> ---� Mailing Hddress City Z�p Phone <br /> peecribeProuosedwor�ew single family residence, Lot l, Glenha+ren Heiahts _ <br /> — ------ -- -- -- -- � <br /> ----- 5� 1-�-'_—�`L-'�t'�-� c�. 1-J. � <br /> Proi��ct ACdress Id knovin) __ <br /> � <br /> Attach four�4)copies ol Plans for proposed work- Drav:to sc�le and nute ihe fullowing as applicable: � <br /> • Property Lines O Centerline of s!reet <br /> • G��tline and dimension:of ail e.istina and • Indicale Nor�h <br /> proposed structures on the lot • Show any proposed �rading changes <br /> ! Exie,ting and proposed ulitilies • Show measuremr.nL. � <br /> �'��°���� pO�F107 NRII�-E B�E1��W�TH��S LIN��_ <br /> � <br /> PERIv11T CONDITIONS � <br /> t AII calle(or inspection shalt be made 24 hrs.i,i advance-phone 259•381 U. <br /> 2.i+!�wnrk shall be pedormed in accordsnce w�lh this permit and current Gity of Eveielt Design and Conslruc[ion <br /> Sta:x�arJs and S�ecifications. � <br /> 3.Call Loc:tion Underground�ervic=40 hrs betere you dig.TOLi.FREE NUMBER 1•800-424-5555. <br /> 4 .A�`Y CN(�[VG� IN TfIC DRiVE'A9'i CUT MtTST BE APPROVED � <br /> BY TE[E PtiNi�I� 'iORiCS TNSPECTCR. ,� �,a,�,�c�, �. S1L-��l <br /> 5 .CONNEC'I DJW.NSYqU'fS TO '!lIi-F.'�7..t%ff�S—BRf��', � J3`"� t" � ( ' � <br /> 6 .KEEP CI`CY STREE7'S ''�,GAH AT ALL TIMES . <br /> 7 .L!NY DAL4E.�xh TO YHG GCiB AND SIDEWALK WI:�L BE RE.PAIRED /� <br /> TO THL� SATISFACTI4fd i�E '"HE PUBLIC 'r�ORKS DCPT . \� <br /> a <br /> / _ P.CKKOWLFCGFMENT OF CONDITIONS <br /> ��U The unaersigned o'.vner/apphc�rt hereby agrees to hold and save hann- <br /> __ 1� — — — I less Ihe City of r.vereft irom any �r.�i all claims lor damac�es, r,os�s, <br /> expeuaes, or causes of acliui Ihat may °.�ise because of installation <br /> (^/ � + ii Cy�� � and rnain�enance of the improvement or o!he� riqht-of�way use horelo <br /> .�/ E.tG� ��Li`��� � �" applir.d lor and furiher a�rees lo remove same uH,n notice Irom ihe <br /> �— Date <br /> Approved for Consiruc 'o . City �nd !o replace puG�'c prel�erty damage ere <br /> / _ / JQ� <br /> �it� ���a��/ " .. //�(r -7rd � �J / S I/n �6 <br /> ✓ ' —G=� ,/ ✓t l � <br /> FINAL INSPEC ION �a« �Date <br /> Approved as Constructed SignaWre o Ap�licanl <br /> VJORK AUTHORIZEO HY THiS PERMIT MUST BE STARTED WITHIN <br /> , everett PUBLICWURKSDFPARTMENT •.pp p{�YS OF DATE �ERMIT IS ISSUFD ANU THEREAFTER IS TO <br /> 3200Ge�ar Sireel � 6E DILIGENTLY PURSUED ��O COMPLETI7N. THIS PERMIT MAY f1L <br /> �� everett,'NA 98201 I CAIJCELLED BY THE CITY UPON A:VY STOPPP.GE OF V'JORK ON THIS <br /> Pl,one:259� ;810 PROJECT OVER 90 DAYS D JRATIUN. � <br /> � <br /> I <br /> J <br />� . - _._. __.._ _ .____ ___.. .._ . . �� ������.������.��sM�as��.�r <br />