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Date x��$ TO PGSiING �✓ �V C�� PublicWo�ksPormita �� oID � <br /> 12-29—J4 � ApplicationFor Omg.Deol.x 46594 <br /> PiJBLIC VI�ORKS PERMIT PubTo�TFeeFeo g <br /> Le55 AOPI.Fee Pmtl 5 <br /> Baianca Due � �O <br /> Print or Type Only � <br /> � <br /> Temiyson Homes Inc 815 6eh St S Kirkland WA 98033 827-9060 . <br /> Owner Mailing Address City Zip Phone <br /> Ed Tennyson <br /> Applicant Mailing Address City Zip Ph�ne /� <br /> \� <br /> Describe Proposed Work New house — Basic 296 <br /> 0^/0�/45 1^:46F'M f7MqEfR9� �. <br /> / <br /> BLCG• •�SE5.50 _ W <br /> Proiecl Address(if known) 5819 12tn Ave W Lot 62 Merril�l�FG�k Gar��t�Q � <br /> i L <br /> � Atlach four(4�copies of plans for proposed work- Draw to scale and note die foilowing as applicable: SF.CHh.0 34.50 � , <br /> • Pronerry Lines • Centerline ot sVeet DF.IV�V 220.00 ♦A <br /> • Outline and dimensions o(all existing and • Indicate North g�DG 4;D.00 ��� <br /> �. proposed structures on the lot • Show any proposed gredi����Rb <br /> • Exisling and proposed u�ilities • Show measuremenis � <br /> WpTER 3105.00 <br /> DO NOT WRITE BELOW THIS LINE � O <br /> SEWER 370.00 <br /> PERMITCONGITIONS S;�S�EV 1S�?62.00 <br />, 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•881 O. �N���ons�Yu��foh�� � <br /> 2.All work shall be performed in accordance with ihis permit and current City ot Everelt Desig � <br /> � Standards and Specification�sr. ,a <br /> � ,�3.Call Lgci�jpr���4dgfP�PN?S'ran�a��il��i��c�Sbefore you dig.70LL FREE NUMBER 1•800-424•5555. � <br /> I' <br /> 5. i;uib Kuiizr and sidrwalk in iLe pla[ are new a��d undamaged, any damage iherzto st�all bc replaced at ttie <br /> discrclion of lhc PubGc Wo�lcs Uispectoe o <br /> (. Airv chanoe iu Ihr. d�iveway cut mnst he apprm•ed bV the Public LVod<s Inspecloc widll� al prop linz <br /> IIIWIGII IU C.U�IIII�' e��1Ull WIIII�L D1R'GR';ly Ill;ly I8NC1 �IBIIUaIIy to we;el gara�e duur euU:wa (for:m � <br /> approv;d 3 car�u'abe). <br /> 7, Adjnst water boxes lo p_,rade at end of co!istmctiou. �/� <br /> S. lltivcways �hall Lc co�npicicly curcJ befor Jtivuig ua thcni. ��� <br /> 9, hooRop drainage shall be dischar�ed to ihe lets intiltration trcnch as per Ihe "Residenti�l Foof Downspout O <br /> aysiem' du�ail ia�iacl�ed) aud as per ihe sizin�aud locauuu inFoimation on ihe loPs si�e plan. A � <br /> prcconsliuctiom m�ciu��,must bc schcdulcJ�eith Alla�i Lockc (338-9G55 mob. or 259-S810 office) prior to <br /> instaiistioa �I'thu inliltr,dion system. AiN ch�n�e in Ihe intiltrafinn Irench nmst be �pproved by the Public <br /> u'oiLs [i�speelui. <br /> ACKNOWLEDGEMENT OF COfJDITIONS <br /> The undersigned owner/applican�hereby agrees lo hold and save harm� <br /> less the Ciry of EvereU �rom any and all claims lor damages, costs. <br /> expenses, or causes of aCtion that may arise because ol installation <br /> ��2 � y�- and maintenance of the i ovement or olher right-ohway use hereto <br /> ap � d f r_aRd further grees o remove same upon notice Irom Ihe <br /> Approved lor Construction �a�e it eplac ublic pr\ damaged thereby. <br /> ��-.— �' .,1 I' 91� � � <br /> FINAL INSPECTION Date ' <br /> Approved as Const�ucted Signature ol App�cant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTAIENT 180 DHYS OF DATE PERMIT IS ISSUED AND THEREFFTER IS TO <br /> 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DUFATION. <br />