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. n. <br /> .A <br /> I) <br /> j <br /> r (0z 4z - <br /> tlH 'Ov Date. 1—A-97 Tn PpS . ING I�(- wnik w°n.v.rmn. <br /> W H Application For "Wit Dept • ",?.rr-35279 <br /> H � <br /> C) PUBLIC WORKS PERMIT °°°'"w°F"e <br /> aWGAG s <br /> Lose Awt r„P.M S <br /> (,] O a&LrK.Due Z< <br /> a 0 Print or Type Only <br /> ti a <br /> H �. r•, c, r� �r c� n fn n o- a <br /> e <br /> p7 y H Hambrook Inc E. 4020-MaitL Spokane MTA 99202 (509) 534-0644 <br /> CCO qb En Owner Mailing Addr4e- ({({rr��r ' CRy j L Q' Zip Phone <br /> z H y Owner Q pla i-n AM 1=1 •. . <br /> H O rn Applicant Melling Addresssn•�- City Zip Phone <br /> Describe Proposed Work new SFR <br /> I <br /> W i <br /> I <br /> Project Address(11 known) Fl(- SC <br /> I Attach lour(4)topica of plane for proposed work•Draw to stele and note the following as applicable: <br /> I • Property.'nes • Centerline of street ♦^ <br /> Pe Y W <br /> i • Outline ami dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements ca <br /> C� 00 NOT WRITE.BELOW THIS LINE W <br /> PERMIT CONDITIONS p <br /> 1 1.All calls for Inspection shall be made 24 hrs.In advance•phone 259.8810. <br /> ._ 2.All work shell be performed In accordance with this permit and current City of Everett Design and Construction <br /> 1`— Standards and Specifications. <br /> 3.Call Location Underground Service 48 him before you dig.TOLL FREE NUMBER 1.800.424.5555. z <br /> 4. Install rock construction entrance behind driveway as per city <br /> standard #208 and erosion control as directed by Public Worker <br /> elate Inspector. <br /> 5. Keep city streets clean at all times <br /> 8. Curb gutter and sidewalk in the plat are new and undamaged, <br /> any damage thereto shall be replaced at the discretion of the // <br /> � <br /> Public Works Tnepector. V) <br /> 7. Any change in the driveway cut must be approved by the Public /^ <br /> Works Inspector. 0 <br /> 8. Tightline all roof, yard and driveway drains to storm drain <br /> stubs at back side of sidewalk. <br /> 9. Ad3ust water boxes to grade at end of construction. <br /> 10. Driveways shall be completely cured before driving on them. <br /> 'l <br /> 1-0 <br /> 1 ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicaht hereby agrees to hold and save arm• <br /> l9 <br /> less the City of Everett from any and all claims for damages, costa <br /> expenses, or causes of action trial may arise because of installalior, <br /> 31 —Cf and maintenance of the Improvement or other right-of-way use hnrelo <br /> applied for and funhrr agrees to remove name upon notice from the <br /> Apprbved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF GATE PERMIT IS ISSUED AND THEREAFTER IS TO <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 /> i <br />