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Date 1�z4��0 <br />Applica�ion For <br />PU�LIC` �lll�RKS PEF�i�9T' <br />Print or Typa Only <br />Select Homes P.O.IIox 709 <br />Owner <br />Owner <br />Applican� <br />t•fukilteo, P7A 98275 <br />Pdailing Address <br />827-8196 <br />City 2ip <br />PubM1c Wo�hs Permll a � / <br />BI490ept+ 90/2379 <br />Puobc worFs V'ee S <br />Tolal FC� <br />l.ess nooi Fee Paia $ �l <br />Balance Duc S f--�^ <br />Phone <br />Phone <br />Plew Sin le Famil Residence �i-,;zi <br />Describe Pronosed work g Y , Lot J-7, Glenhaven Heights <br />TE+ AVE <br />Project Address Iif known) <br />Attach four (4) wpies of plans lor proposed work - Draw to scale and note Ihe following as applica6le: <br />• Properry Lines <br />• Outline and dimensions of all ex�sting and <br />proposed structures on the lot <br />• Existing and proposed u�ilities <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changc; <br />• Show measuremeNs <br />PERMIT CONDITI4��!S <br />1. A:I calls for inspec,�o�� shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall 7e pe.iormed in accordance with this permit and current CiP/ of Everett Design and Construr,tion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you di�. TOLL FREE NUMBER 1-L�00-424-5555. <br />4.ANY CHAt1Gg IN THE DRIVHWAY CUT MUST BG AFPROVEll <br />BY THS PUBLIC WORKS INSPSCI'OR. <br />5.CONNECT DOWNSP'JUTS TO 'F��'d-�;,'^.^. .^.:n��T. WgL,�L, pZq�NA��L �`fS7�'-� <br />6.KEEP CITY STftEETS CLEAN AT 9LL TIMES. <br />7.ANY DAMAG6 TO THE CURH AND SIDEWALR WILL BE RGPAIRED <br />TO THG SATISFACTION OI' THE PUBLIC WORKS DEPT. <br />���� � /� L,;� <br />`il�((��i! 1 �' l �l�' z y/�' C'. <br />Appmded tor Consiruction / ate <br />�; <br />�/ i<�"`.� ��� /-%G <br />FINAL INSPECTION Date <br />qpnroved as Constiucted <br />evcrett PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Stree� <br />Everett WA 98201 <br />Phone:259�8810 <br />The unde�� <br />le: s ihe ( <br />exF ^nses, <br />anc ":ue <br />applied fc• , <br />Citvand to re <br />.�.�CL��c,! . <br />, <br />ACKNOWLEDGEMENT OF CON.71TIOf�S <br />•d owneriapplicant hereby ayrees to ho�d 3nd save harm- <br />1 Everett from any and all claims for ,iamayes, r,osta, <br />iuses of ar,tion that may ar�se beca� � of installation <br />� of the improvement or o�bar rigl•t-c �oay ase hereto <br />further agrees to removr same upo� notice Irom ihe <br />�ce puUlic operty damaged thereby. <br />�!�Zc'77'y�L�' / / <br />SigrfaWre ol Applic�S�"� �— ') r �� Date <br />WORK AUTHORIZ U BY THIS PE9M1T MUST Bc �STARTED WITHW . <br />180 DAYS OF DATE PERMIT IS ISSUED AND ?HEREAFTER IS TO <br />BE DILIGENT�Y PUHSUED TO COMPLETION. TFIIS I'FRMIT MAY EE <br />CANCELLED EY THE CITY UPON ANY STOPPAGF Or WORK ON THIS <br />PFi JECT OVER 90 DAYS DURATION. <br />