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Date �/9/95 ry�I I �� � (� <br /> l Publ¢Works Pmmil a r� O��/ _ <br /> Application For ��c <br /> ��� BI4U.DePt�--YU�-E1 J <br /> PUBLIC WOR6CS p����:��� / c �S P�bTot�FeoFoe � - <br /> �O J <br /> O Less Aopl Fee Pai� $ <br />� Print or Type Only " p �n <br /> ,i � o n n v�i o r,� n � � Balance Due $��v y <br /> Ua OJ t"! O G �7 O In O CJ r� ( , <br /> O v] �O �O .�+ w [..l O [� 1l 0] � <br /> J' t4 1R bl bi � M �} ��.� `� <br /> Seiect homes ;nc 12811 8th Ave `iJ !t�`�pl EverQ�t"' r9gZp`�' ;r� 513-9006 { <br /> Owner Mailing Atld[as�, .�j � <br /> 1 O O CV =' � S� o � o w o ��Z�P Phone <br /> � n .r � � � k �r o ¢ .�nw � x <br /> _ r scm � x= m �� nYeaacracnr� <br /> Applicant Mailing Address ���Y <br /> Z�p Phone � <br /> Describe Proposed Work _ m }, Rasi�28j___�a,J�,j��� — \ 1,���, <br /> J <br /> Projed Address(it knr,wn� 5801 1?th Ave i•: _ Lot 65, P]errill Creek Gardens � <br /> Attach four(4) copies of plans for proposed�vork- Draw to scale and note the foli�wing �s applicable: � <br /> • Proper�y Lines • Cente:line of siree� <br /> • Outline and dimensions ef all existing and • Indicale Norih � <br /> proposed structures on the lot • Show any proposed c�rading changes <br /> • Exis�ing and proposed utdities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE ■�i <br /> PERMIT CONDITIONS o <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction � <br /> Standards and Specifica�ions. <br /> 3.Call Loc.:�ion Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•$00-424-5555. <br /> 7 ItC:i�l CIIY ifI�P.1S CIC;III ;If 31I fU11C5. � <br /> 5. Carb Kuticr a��d sidc4va�:in thc plat �t'c ucw and undum�gcd, �ury datuag.; thcrcto .,h.�ll ba r:placcd �t iFc � <br /> discretion ot'the Fnblic W�orks Incp��tor. <br /> ci. A�rv chanve in tlie dricesv�y� cut musi bc approved by ihe I'ublic 1Vorks Inspector, width at prop Gne � <br /> limiteJ lo erisliti,apron ti.�idlh. Driti•e�v�y m��taper ��du�illy to rneet €;ara�,�„ door entrancc (tbr an <br /> approved 3 car eararr). f/� <br /> �ldjusl wsler boxes lo �,iade al eud ��fconshuctiou. \/� <br /> S. Diiee�v��s s�i�1J be coinpletety cured before dmvig on Ihem. � <br /> l. hoollvp dr;dnaee sh9II �C (JISI'I79fnC(I t0 (Il� IOtS 11111)fi�hOtl RtI1CI1 JS�)C!IIn °h�:�ictential hoof.Duwnspout A <br /> Sysleni' �ietail (�ttachcd) a�id as p�r tlre �ucig m�d Iocation infonnatiou on tlte IoPs site pl;ui. A li <br /> preconsmictinn mectin�must be schr,d�deJ witL Atan I,ocke (3SS)655 mob. or 259 831�� ofl:ec) prior lo <br /> installation of Ihe inliltration sy,tem. Any clivi��. in tl�e intilUati..0 trench must be approved by tl�c Patrlic <br /> «�GCIC� IRS�)CCIUL ACKNOWLEDGEMENT OF CONDITIONS <br /> The imdersigned owner/applicant hereby agrees to hold and save ha.m� <br /> less the Clty of Everett from any and all claiTs for damages, costs. <br /> �� 0 eapenses, or causes of action that may arise because of installation <br /> �G�/ G � / 7/ls" and maintenance ol the improvement or other righbof-way use hereto <br /> Approved for Congtruction Date app11ed fOr antl furiher agrees to remove same upon notice from ihe <br /> City and to replace public property damaged thereby. <br /> C � ! <br /> ..2�:_�, — I — �-G� - J'� <br /> FINAL INSPECTION Date �h z/Z/ /-�j�5 <br /> Approved as Conslructed Signature ol Ap ucant <br /> Da(e <br /> ���� PUBLIC WORKS DEPARTMENT WORK AUTHO IZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,VJA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT MAY BE <br /> Phone:259�8810 CANCELLED 61'THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATIOfJ. <br /> �� <br />