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Date_—3 24-93 7i -e-Fq-4 Public Wonge Permit• X13 D _BICp Debt 40018 <br /> Application For <br /> OMS <br /> PUBLIC WORKS PERMIT `J ' Pub tow FeeFee 5 <br /> T <br /> o IOS11 IIYG 'JT�• uAOOI Fee PueB <br /> Beiance Due <br /> Print or Type Only <br /> -1' <br /> Countrywood Homes 14410 Bel ted Rd Suite 200 Bellevue WA 98007 phone <br /> Owner Melling Address r riy Zip <br /> Owner Zip Phone <br /> Applicant Melling Address City 1 <br /> r <br /> Describe Proposed Work new house <br /> (J <br /> Protect Address(if known) <br /> 2612 58th St SW Lot 16 <br /> Attach lour 141 copies of plans for proposed work•Draw to scale and note the fullowluteolin of street hie: <br /> • Property Lines • Centerline lne of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> • Show any proposed grading changes <br /> proposed structures on the lot <br /> • Show measurements <br /> • Existing and proposed utilities f� <br /> r DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 his.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 Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> 4 behind drewy as er Cit <br /> 4 Install standard r0208ock cand terosion control ruction eas directed byaPublic Worksy o <br /> Inspector. <br /> 5. Keep city streets clean at all times L <br /> 3. Curb Butter and sidewalk in the plat are new and undamaged, r <br /> any damage thereto shall be replaced at the discretion of the <br /> Public Works Inspector. <br /> 7. Any change in the driveway cut must be approved by the PW In- <br /> spector, width at prop line limited to existing apron width. v <br /> B. Connect all roof, yard and driveway drains to storm drain <br /> system provided to lot. am <br /> 9. Ad,;ust water boxes to grade at end of construction. <br /> 10. Driveways shall be completely cured before driving on them. <br /> fI <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ^A The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costa. <br /> expenses, or causes of action that may arise because of installation <br /> t7/1L /f �Z�y2 and maintenance of the improvement or v other right-n hotiwaY use hereto <br /> J� `T 7 applied for and lurcher agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION 'DateSir Date <br /> Approved as Constructed WORK lire of A IZEDBY THIS l <br /> RMIT MUST BE STARTED <br /> PUBLIC WORKS DEPARTMENT <br /> 180 DAYS OFF DATE PERMIT ISEISSUED AND THEREAFTER ISTO <br /> 3200 Cedar Street 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 DURATION. <br />