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C)at�., 1/24/90 <br />qppiir,ation f'or <br />PUBLiC W�RKS P�RMIT <br />Print or Type Only <br />,. <br />CubLc Works Perme . �"� /� t�.� <br />oia� oen�. +_�30 2 3 0 -- <br />Pvpbc Works Fce <br />Total Fee 5 <br />LessAOPI FcePaitl 5. <br />BaianceDue S L� <br />Select HOmes P o Box 7 8 �^ ,k' 7,_r_eo_wh 98275 827-8196 <br />Owner Mading Address Ci�y Zip Phone <br />Applicant <br />Describe Proposed VJork <br />New s <br />Mailingl,d <br />c,��, Z;� <br />residence, Lot 13, Glenhaven !ieights <br />Project Address iit kno�.vn) _ �CJ ��� ._J � n /��,�� �, _I � <br />Atlach four (4) c�pies of plans tor G�opc.:ad work - Draw �o scale and note �he fcllowing ps anolic <br />A Praperty Lines <br />• Outline and dimensions ol all exisf�ng and <br />p�oposetl siructures nn �he lot <br />• Existing and propo�,=d utilities <br />• Centerline of sV�et <br />O Intlica�e North <br />O Show any pr000seU grading changes <br />• Show measurn,rents <br />�•.�rvvivvnnttyt�UwiHISLINE -- � <br />FERMITCOND�TIONS <br />1. All calls for inspection shall be mada 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Evereq Design and Conshuction <br />Standards and Specitications. <br />3. Call Location Underground uervice �r; hrs. belore you dig. TOLI_ REE NUMBER 1-$00-424•5555. <br />4.ANY CHANGG IN THE DRIVEF'AY CUT MUST BE APPROVED <br />BY THH PUBLIC WOkKS IN�PECTOft. <br />S.CONNECT DOWNSPOUTS TG T-�jp�' r'���lp�no�.�_ �gL�L pr��,IN/.�,L ,�-i,��;� <br />6.REEF CITY STR6GTS CLBAN AT ALL TIMES. <br />7.ANY DAMAGfi TO THE CURB AND SIDEWALR WILL BE REPAIRED <br />TO THE SATISFACTION OE TH� PUBLIC WORKS DEPT. <br />� <br />� �] y�",,� � <br />- �l'�,V`� � �i"CS: � � �- -� <br />Approved for Constructi � j )ate <br />Cti-� �/ `�-1 � - y/ <br />FINAL INSP CTION Dzte <br />Approved as Constructed <br />>verett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Evered, WA f18201 <br />Phone. 259�3810 <br />ACKNOWLEDGEMENT OF CONDITIOP'3 <br />�J <br />The undersigned ownar/appticant hereby a�rees to hoid and save harm� <br />less the Ci�y ol Everett from any and claims for darnages, �osts. <br />expenses, or causes of action that may arise becfluse of inst?!�ation <br />and maintenanc= of lhe improvement or other right-oFway use hereto <br />app ied for and further agree5 to remove same upon �otice Irom the <br />C�iQ a(yqd� t'o /rqpl% �e pu�b�li�c prop dama ed Ihereby. <br />�'�"uWI /�� � 1,� !/ i' �",r <br />v� � <br />i <br />/ ,,�, <br />'ig ature of Applicant p��P <br />WORK AUTHORIZED BY THIS PERM'T MUST BE S'JRTED WITN!IJ <br />180 DAYS OF DATE PERMIT IS ISSUED AND THLFEqFTEH IS TO <br />BE DILIGENTLY PUHSUED TO COMPLETION. TFiIS PERMIT MAY BG <br />CANCE�LED BY THE CITY UPON APiY STOPPAGF OF V/ORK ON THIS <br />PROJECT OVER 90 DA`!S DURATION. <br />