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i <br /> M <br /> PO N r Pub�w W., a Pume [Q'.9 <br /> [Gy' eNlo herr, <br /> Date_33�Z --- <br /> n Application For A,bimw11-lite s--, <br /> %7 WORKS PERMIT T.WrTe <br /> ° PUBLIC <br /> b H H LSU eWI fee Paid $----�� <br /> � Z Ba�wce Due <br /> to Tn nnKlI fT Iz'f7'R <br /> to Print or Type Only <br /> Cl • 644-2323 x142 <br /> ~ 14410 Bel-Red Rd. 0200 Belleuve WA 98007 Phone <br /> H Countrywood Romes y CitZip <br /> w Mailing Address Angie Stevens <br /> pQ to Owner \ <br /> C <br /> to Phone <br /> tel � owner Melling Address City Zip <br /> O y APPller t w <br /> SFR <br /> Lot 20 - 3bwo �-1`'ILL <br /> Describe Proposed Work 1 ' <br /> 9e .1 <br /> 7_51Cn <br /> Project Address tit known) applicable: <br /> •Centerline of street <br /> Attach lour 141 copies of Plane for proposed work•Draw to scale end note the following as CIO <br /> • Property Lines • Indicate North <br /> out • Show any proposed grading changes <br /> • <br /> proposed structures on the lot mensions of all ■Islin9 and • Show measurements ca <br /> j • Existing and proposed utilities <br /> C O <br /> DO NOT WRITE W BELOTHIS LINE <br /> PERMIT CONDITIONS <br /> M 1.All calls for Inspection shell be meds 24 ane it advance• t Design and Construction <br /> Phone 259.8810. <br /> 2.All work chat]be performed in accordance with this permit and current Cay of Everet <br /> oftStandards and Specifications. <br /> 3.Call Locaton Underground Service 48 firs,before you dig.TOLL FREE NUMBER 1.800'42n V Fir, <br /> r 4, P O <br /> 4 Ins standard rock <br /> condter tion COntrolr as directed` PW�Pn11,1 .ir` r t. <br /> Inspector. <br /> 5 Keep city streets clean at All times and I two <br /> Ad <br /> t3. Curb gutter <br /> theretodAhall be replaced At.Pt,hewdieCret.lonOfthp <br /> any damaq - <br /> e <br /> Public Works Tnepeotor.hdrivewacut must be o <br /> 7, Any change in the y epproved by the PW r <br /> Spector' <br /> wto <br /> idth at prop ].i.ne limited drninseXiet.nnstorm drain <br /> p apron th <br /> g• Connect ell roof. Yard and driveway <br /> system provided to lot.ran <br /> 9. Ad3ustae <br /> water <br /> bl hP toimpletelvtrnredend of construCtion. n them. <br /> before driving o <br /> 10. <br /> �_r♦ ACKNOWLEDGEMENT OF CONDITIONS <br /> � pnanl hereby agrees to hold and save harm- <br /> a"]\ The undersigned owner/app <br /> expenses.for causes r ell action e that may ny and all <br /> erisei damages. <br /> because of nstallal on <br /> ^ 1� and maintenance of the improvement or other light-01-WRY <br /> notice <br /> use hereto <br /> '`rte applied lot and further egress to remove same upon notice Irom the <br /> Dale City and to replace public property damaged(hereby. <br /> Approved for Con• Iron <br /> sz <br /> ��„•_ � Dela <br /> Date Ignature Applicant <br /> FINAL INSPECTION <br /> Approved as Constructed WORK AUTHORIZED SY THIS PERMIT MUST BE STARTED WIT <br /> WarrPUAIS <br /> BLIC WORKS DEPARTMENT fee BE DDLIGENTLY PURSUED TOAYS OF DATE PERMIT ICOMPLE?TONTHIS EPERMIT MAY BE <br /> 7200 Cedar Streel CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ONTHIS <br /> ���7ekrn Everett.WA 98201 I PROJECT OVER Be DAYS DURATION. v/ <br /> Phone:259.8810 <br />