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Cd.te 1%�4/9C <br />Aoplir.ation For <br />PUBLIC lIPI'C�RKS PERMIT <br />Print or Type Only <br />Se��ct Homes <br />Ow��.:r <br />SdifiE3 <br />Applicant <br />Describe Proposea Work <br />Prolec� Address lif known) <br />P.O. Box 708 Mukilteo <br />Mailing qtldress <br />Idailing Address <br />WA 98275 <br />City <br />827-8196 <br />Zip <br />/ <br />' .>�Rrmne �C.' �� <br />w.,,, �rr� . __ �23805. <br />vubuc Wo�ks fee <br />Total Fea $ _�� <br />Less Appl Foc Paltl S <br />a��,�«, o�� S _�c_ ' = <br />New single fanily residence, Lot 20, Glenhaven 9ei�hts <br />Altsch four (4� copies of plans lor proposed work <br />� Z � C�� A.`. <br />W <br />Draw to scale and note the following as applicable: <br />U Prop�rty Lines <br />• Outline and dimensions of all existing and <br />proposetl structures on the lot <br />m Existing and proposed utilities <br />• Centerline af streel <br />• Indicate Nortn <br />• Shooi any proposed c�rading changes <br />• Show measurements <br />Phone <br />Phone <br />PERMIT CONOITIONS <br />1. All calls for in;pecl�on shall be made 24 hrs. in advanca - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current Ciry of Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Servic= 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4.ANY CHANGS IN THE DRIVEWAY CUT MUST BE APPROVED <br />BY TH6 PUBLIC AORKS INSP6CTOR. <br />5. CONNECT DOWNSPOUTS Tp 'F!{gy—gy�g�—��5, �`�6� �L ��i�f ��`.� ,,�J�,� <br />�.KEEP CITY :iTREGTS CLEAN A1' ALL TIP1E5. <br />7.ANY DAMAUE TO THE CURB AND SIDEP]ALK WILL BE REPAIRED <br />TO TF[G SATISEAC'7.C,N OF THE PUBLIC WORKS DEPT. <br />.��� ��� �� , � ��,1 <br />Approved for Constr��c�� --�—�- I N <br />FRJAL INSPECTION <br />Approved as Cnnst�ucted <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireet <br />Everett. WA 98201 <br />Phone:259�8810 <br />��_�,�-s� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owr.er/applicant hereby agrees (o hold anG sac� ha ,�- <br />less the Cily of Everetl (rom any and all claims for da�nac�es. cos�s. <br />expenses, or cauoes ol aclion that may arise because of installation <br />and maiMenance of the improvement or other ric�ht�o1-way use hereto <br />applied for and further agrees to remove same upun nolice from the <br />Ci a to re . ce public p� perty Jamaged thereby, <br />,,��'��/, �� yp��. <br />�G <br />5igna ure ol Applicant <br />WGRK AUTHORIZED BY THIS PERMIT MUST BE STANTED�VJITHIN <br />180 DAYS OF DATG PERMIT IS ISSUED qND THEREAFIER IS TO <br />BE DILIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAY 8[ <br />CANCELLED BY T��1E CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER ^ -)AYS pURATION. <br />