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Date z-2-�5 <br />Applicalion For <br />PU�LlC VE/nRKS <br />Print or Type Only <br />Ra <br />621 Ok Ptill Rd <br />�� !�'(?$T�HG �S -Z l�-�� <br />PE�MIT <br />¢ <br />O <br />n <br />Maihng Address <br />- G)ac,o 000 <br />r_ inoaov�on <br />P `Y' .H � O O J- O N� <br />[..J ,.] 6l vl N W CJ Gl <br />ul +N M w �R �q <br />�n yi M <br />iomis"h 98290 334-08 <br />� �, �o c�tv c� .:- <br />� O U' (�1 S G'J 1 3[.J <br />'+ O�(iiLlC] U? W <br />ri a o�i � r m n o � <br />Gity <br />Describe Proposed Work <br />Lot 8 112th St SW Estates <br />Prolect Address �if known� 11122 17th <br />up <br />Pi�bhc Works Pcrmu � _J�W"�/ _� <br />oma e�o� . 46900 � <br />PubLc WorFs Fee <br />Tolal Fee $ _ <br />Less FppL Fee AmJ $ ___ <br />� ' <br />palance Cuc $ � <br />Attach fow (4) copies ol plans for proposed N c•k :raw to scale and notc the lollowiny as applicable: <br />• Properry Lines O CeMerline of streel <br />s Outline and dimensions ol all existing and O Indicate North <br />proposed structures on the lot • Show any proposed 9rading changes <br />s Existing and proposed utilities • Show measurements <br />�r <br />:111 , <br />LINE <br />F'hone <br />PERMIT CONDITIONS <br />1. All calls fer inspection shall be mad� 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pertormed in ?�cordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />�. Call Lo�eti$T� flhtierljPSlinQ�@Poi&� 2a�i Ni�.ttSefore you di9. TOLL FREE NUMBER 1•800•424•5555. <br />�. Curb eul�er ;md sidew,ilk in Uie F!laf �rc, nzw and und,image�i. any danm�e ihercto shali be replace�i �it Ifia <br />Ji: crction of Ih� PubGc �Vodts �ispector. <br />6 hrry ch�nee in Ihc drivcwrn� cnt ntu;� bc approved by Ihe Public Works Inspector. widih at prop line <br />liiuiled Iu exi>luig ;ipiun w�JUi. P.rivc�vay iaay laper �;radually lo wnel ear��;c dou� euUcwc� (for au <br />a���n�ov�d � car garaoe). <br />7. Adjust w�tcr boxes to cTBfIC 8I Clld OI COIIs1I11Ch011. <br />3. Lots 5 tiuu 12 ;h:�l �lisch�u�,e roollop dr�iage to tLc stonn dr:w� ,hib pro�ided to the lot. <br />�. Lois 1 tlini 1�L;dl disrtcuec rooRnp drainagc to the lots infilhation trench as per the "Dispersinn Tnnch <br />D�iail" on shce� � ot ihe plais consiniciious plans. A preconsiruciiou mectin� must be schednled wiih �U; <br />Lockc (33S-9GSS mob. or 2s9 �S10 otTicc) prior to u�stallation of ihe in(iltralion �,yslcm. Any chanoc in <br />the intiitr,dion trench nuisi i�c ;�pproved bp Ihe Public 4Vorks Inspector. <br />�r <br />FINAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DFPARTMENT <br />320o Cedar Street <br />Everett, WA 98201 <br />Phone:259-8870 <br />� � I � <br />Date <br />ACKNOWLEDG[MENT OF CONDITIONS <br />� <br />0 <br />� <br />V♦ <br />O <br />a <br />The under;igned owner/applicaM hereby agrees to hold and save h�rn- <br />less ihe City of Everetl from any and all claims for damages. costa <br />expenses, or causes of action ihat .-,�ay arise because of installation <br />and maintenance o� the improvement or olher right-of-way use he�eto <br />applied for and luriher agrees to remove same upon notice Irom thr <br />.City and to replace pu4 �c properry damaged thereby. <br />i NuC� / �—��'�.__t_ <br />Signa�urE f Applica T n�.��� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THiS PERMIT MAY BE <br />CANCELLED BY THE CI7Y UPON ANY STOPPAGF OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUfiATION. <br />._ -.�""-- ---�--�- -- <br />__..�,.� _q.�.�.... -- - - <br />