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Date , ,� � ,�p <br />Application For <br />PU6�LIC WORKS PERIVIIT <br />Print orType Only <br />Select Homes <br />Owner <br />Applicant <br />P.O. Hox 708 tdukilteo, WA 9f3275 827-8196 <br />Mailing Address Ciry <br />Wailing Address <br />Zip <br />Crty Zip <br />✓ <br />Pubi�_ Works Pc:mq • �L� ��, <br />amq. Den�. • _ q�l����Yv � zan2 <br />PubOc Works � eo <br />Tolal Fee 5 <br />Less �ppl. Fee Pal� S <br />Balance Due �u Z�� <br />oescribe Proposed Work New Single Famil.y Residence, Lot 19, Glanhaven Heiqhts <br />Projecl Address �il known) <br />Atlach four (4) copies of plans for proposed work - Draw �o scale and note the following as applicable: <br />• ProUertp Lines <br />• Outline and dimensions of all exisling and <br />proposed sirur.tures on the lot <br />• Exisling and proposed utili�ies <br />,�� <br />• Centerline ot street <br />• Indicale North <br />� Shew any proposed 9rading chanyes <br />• SI-�osv measurements <br />NOT WR <br />Phone <br />Phone <br />PERMlT CONDITIONS <br />7. All call, for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />7_. All work shall be pertormed in accordance with this permit and current City ot Everett Design and Construction <br />Standards and Specilica��ions. <br />3. Call Location Undergrour�d Service 48 hrs. before you diy. TOLL FREE NUMBER 1-800•424-5555. <br />ANY CHANGS IL� THE DRIVSWAY CUT MUST .�E APPROVL+D <br />BY THE; PUBLIC WORKS INSF�CTOR. <br />CONNGCT DOWNSPOUTS TO 'FFFR�3-GHR$-$Rfi�Nt�, f-'�aL��. D2A�NtiG,Cc sYSTC:ly. <br />KEEP CTTY 5'PREETS CLGAN AT ALL TIMES. <br />ANY DHMAGE TO THE CURB AI�ID SIDEh'ALP. W'�LL BE REPAIRGD <br />TO THE �ATiSrACTION OF TH6 PU9LIC WORRS DEPT. <br />U<.�.0 � lG'F�GL �i �C! <br />Approved tor Constr4 t�on Dale <br />..r"Sly // �7_f-'�O <br />FINAL INSPtCTION Date <br />Approved as Corslructe• <br />everett Pl. +LIC N ; DEPARTMENT <br />� 32G� �ada� .at <br />Everatt. Wr 9 ul <br />Phone: 259-b ,10 <br />ACKNOWLEDGEMENT OF CONUITIONS <br />� <br />� <br />� <br />� <br />� <br />� <br />Vi <br />� <br />a <br />The undersigned owne�/a�plicant hereby agrees to hold and save harm- <br />less the City of Everet� �rom any and all claims �or damages, costs, <br />expenses, or causes ol aclion that may arise because of installation <br />and maintenance of the improvement or othe� right-of-way use here�o <br />applied for and further agrees to remove same upon notice Irom the <br />City and to r=place public property damaged ihereby. <br />���.--k'-� �i - `� j0 <br />Slanature of A— pp ot ���e <br />WORK AUTHORI�CCi BY THIS PC-RMIT MUST BE STARTED WITHIN <br />iB0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BC- <br />CANCELLED BY THE CITI' UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />