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Date <br /> Public Parm Z_=_ <br /> o Worke Application For emv Oepl • !���/___ <br /> PUBLICS WORKS PERMTIOrPOSTING <br /> Plan Check Nor Cti191 Pubb°Worke Fee <br /> Fen S-_ <br /> Applob Addates 05 21/91 Lost AporFe@Peld <br /> Sepa Humbert Xx ', r' pp p p p <br /> Irl 8 8 8 ti ealente Due s <br /> Owner: SINGLE ¢�iDUgg2}�igS m o _ <br /> Proposed Ueer SINGLE F7U1ILYi EEtlQ NCI P�^ '�-' a <br /> De Go- of Works -�-•q+e <br /> NEW WOOD FRAME CONSTROTI I ft eJ -TX QI((��-/.� ya2o <br /> 1143 SPLIT ENTRY r BASUP <br /> AN O� r/I P iUfS,IA <br /> \_ � 3 r iii <br /> OFFICE SET— �j a 6'>,.c^ z }� L3 Zip <br /> _T�TJ D� "'I'm r_ o FF r Phone <br /> APPRVD FOR PERMIT DATE`' r1 - _ �/C �C <br /> City Zip Phone <br /> Describe Proposed Work _ AI O Sv5, n.�r a _ter <br /> Project Address(if known( .Z 3Z (A Ooh ISL 5 E LU <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and <br /> proposed structures on the lot • Indicate North <br /> • Existing and proposed utilities • Show any proposed grading changes <br /> • Show measurements <br /> 00 NOT WRITE BELOW THIS LINE m <br /> PERMIT CONDITIONS O <br /> 1.All calla for Inspection shall be made 24 Ws.In advance-Phone 259.8810. <br /> 2.All work shall be performed In accordance with this permit and current City of Everett Design and Conslru^tion <br /> Standards and Specifications. <br /> 3.Cell Locallon Underground Service 48 has.before you dig.TOLL FREE NUMBER 1^800.424.5555. <br /> 4. Install rocpi constri-tction entrance behind driveway as per cit, <br /> standard #208 and erosion control as directed by Public Wort.,. <br /> Inspector. O <br /> 5. Keep city streets clean at all times <br /> 6. Curb gutter and sidewalk in the plat are new arid undamaged, <br /> any damage thereto shall be replaced at the discretion of <br /> Public Works Inspector. the <br /> 7. Any change in the driveway cut MUSt be approved by the Public <br /> Works Inspector. <br /> S. Tiahtline all roof, yard and driveway drains to storm drain O <br /> stubs at back side of sidewalk . <br /> 9. Adjust wager boxes to orade at end of construction. <br /> Clot <br /> 10. Driveways shall be completely cured before drivinq on them. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Cily of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of Installation <br /> and Minis, ince of the improvement of olher right-of-way use hereto <br /> Approved for ctlon applied for and further agrees to remove same upon notice from the <br /> Co Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Oale <br /> —� <br /> Approved as Constructed L dT <br /> Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259.8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />