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�— <br />Date.�2/� / 94 <br />Appliwtion For <br />PUBLIC MIORKS PERMIT <br />Print or Type Only <br />Srhuck <br />Ovmer <br />3� ��S?I�9� -�`��-�� <br />15621 OK rlill Rd <br />Mailing Address <br />Mailing Address <br />290 <br />.. IPubim Worhs Pcrmil e�4/�y_4_� <br />e;av o�o� • 46367 <br />acv <br />hc Y/mks Feu S <br />To�il Fea <br />Less POP�. Fee Pa�a S—�J <br />O O O O ��"F°'Due � l� <br />V) dG10� <br />[U ti0 G �n <br />!) V� VJ r <br />�} y} �p d! UZ <br />M <br />���17 <br />� �i Z�p � _s .. <br />o c� r']:.0 �.:- v <br />oor,�c�ciyF'''w <br />Y�C O�.l O� UJ'.i rcrl) G C.Z.I <br />Zip <br />Nnone <br />Phone <br />Describe Proposed Work �ew house B� ic 279 -- <br />, I I I 7 I�-�LI ��/"1�� � T t n 7 t'J r I, c r <br />Projecl Address (if knov+n) ��- --- <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following ae applicable: <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed s�rur.tures on the lot <br />• Existing and proposed utilities <br />• Centerlina ot s�reet <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT GONDITIONS <br />i. All calls for inspection shall be made 24 hrs. in advan�e - phone 259•8810. <br />2. All work shall be performed in accordance with this permit ard current City of Everetl Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. T0: L FREE NUMBER 1•800•424-5555. <br />4. b'_rep city sheets cle^.a at nll titnes. <br />�. �urb etiiter ;uid sid;;w:dlc ui tLe plat are new and undui�aged, any darnage iherzto sh;t� be replaced at [l�e <br />cliscr,tion of th� P'ublir \t'orics It;spector. <br />6 Airy chanoe in tl!e dnvew:ry ciU must be apprnved by the Fublic Works Inspector, width at prop line <br />IlII11IGlI IV G%ISII41k ��liUll �41lIIIL DI�YGWBj' 1118Y �J�)Cl �;Ii1l�Ll�) �V IIIGCl �':�78k;C 1�0U1 CIIUfWI'C ��OC:lll <br />�pproved 3 car gara�e). <br />�dju:t w;tter boxes to vrsde at end o1 enus�nte inn. <br />;,. Lols 5 th�u 12 s6�ill disch�ec roonop �rauiagc to ILc slorn� drwi sh�U providcJ to tLc lot. <br />u i_nl� l Ihn+ 4 sh;dl dischar�c rooftc�p drainage to ihe lots infiitrafion trench as prr the "Dispersion'Trench <br />Det,iil" on shec[ � oi ihe plals consinicnons pla�is. A preconsiiuctieu nreeting must be schediJed wiih AI <br />LocLe (3S3-9C,5� mob. or?59';Sl�� olTice) piior lo inslailal'ron oftlie uifdlratiw� systen�. �U�y cha�ige ui <br />the intillration Ireuch must be :ipproved bv Ihc Pnblic `:Jorks Tnspector. <br />ApproveA as Gonstructed <br />PUBLIC WORKS DE�ARTMENT <br />3200 Cedar Slreet <br />Everett. WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />/ — less the City ot Everett Irom any and all claims for dama9es. costs. <br />/� �� expenses, or causes of action Ihat may arise because of installation <br />� f and maintenance of lhe improvement or other righbol-way use herelo <br />applied for and further agrees to remove same upon notice �rom the <br />Date City and to replace pu lic properiy damaged thereby. <br />II( � <br />z �✓! ; ���3 � s <br />Date � � u � <br />Signatur pplicant Date <br />WORK THOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV�R 90 DAYS DURATION. <br />