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✓ate 4/5/95 <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pupxr Wm�� Pprmil • <br />e�no oam • 47969 __ _ <br />Vub�¢ Wort� Fee <br />�otel Fee s _ <br />Uu �PO� fne Pa�C � _ <br />B�hnce Oue 8 _ <br />Silverwood L.P. i2700 NE 124th St Kirkland 98034 822-4174 <br />Owner Malhng Atldress Cdy Lp <br />Pa[ Carr.oll <br />APPllcant <br />Descrlbe Proposed Work <br />P�o�ect Address lif knownl <br />Meihng Address <br />New house - Basic 295 <br />Cily 2�p Phone <br />Site 14 Silverwood <br />Attach lour 14) copies of plena lor p�oposetl wo�k - Draw to acele and �ole thP lollowing a� eppliceb�e: <br />� P�operry Lines <br />• Ou�lme and dimanaions ol el� e�ishng antl <br />propasetl StruCtures On thG lot <br />• E�isting and proposed utllitiee <br />� Centerlina of sVeet <br />• Indi�a�e Norih <br />• Show eny p�oposed grodingchanges <br />• Show measurements <br />NcRMI1CONDITIONS <br />1, Ah cells lor Inapectlon ahell be mede 24 hre. In edvenca • phone 259•8810. <br />2 All work ahell be pedormed In eccordence with thie permit end cvrrent City ol Everett Desipn end Conatrur,tlon <br />Stwndards end Specllicatlona. <br />3. Cell Locatlon Unde�grou.�d Servlce 48 hre. belore you dlg. TOLL PREE NUMBER i•BOO-4Zi:•$F� $. <br />PUBLIC 1"�nl"'! t LpMIT <br />f„�r i,.. :�� .G.� <br />�1'..........._,� -- <br />i�M6 -- - . <br />Approved br Construc�ion Dale <br />FINAL INSPECTION Uete <br />Approved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Cetler S�reet <br />Everell. WA 98201 <br />Phona:259-BBIO <br />ACKNOWLE�G[MENT OF CONDIiIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />a <br />The undersi9ned owner/uppliteM herehy eg�ees to hold and save harm� <br />less Ihe Cdy o� [verett lrom eny end all clalms lor tlameges costs. <br />erpenses, or cnuses ol ecllon that mny erise becnuse ol inslxllThon <br />end maintenence o� Ihe improvemenl or olher righl�obwey u6e hereto <br />epplietl lor end lurther agrees lo remove 6ema upon nohce Irom Ihe <br />Ci�y and to replece pub6c property damaged therehy. <br />Signature ol APpI¢ent Dale <br />WORK AUTFiORIZE'D BV iHIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATF PERMIT IS �SSUFD AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED'O COMPLETION. THIS PERMIT MAV BE <br />CANCELLEU BY THE CITY UPON ANV SiOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 D4VS DURATION. <br />