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r <br /> �y�y�CC <br /> CH <br /> ay [n <br /> 1`4 C3 1–R–g9 1\7 1 IIJI�I\V `d �C !� _ PubiK Works Permit• <br /> W Date <br /> Bldg Deft 92/35281 <br /> H Iry <br /> y H Application For <br /> pz� PUBLIC WORKS PERMIT vumKwoeeFee tt <br /> TN.l Fa <br /> d Len APPI.Fee Paid L< <br /> OH i <br /> C', f Vellum*Due t{ <br /> 0, O Print or Type Ontygyp, u5 '[pS_' � r VeR l p p . <br /> pv rP Cl K ,o <br /> Le "e u" .. <br /> H y 11anabrook Tnc E 4020 Main'M' Spokani'-WA x2,99212 (809) 534-0644 <br /> In Melling Address. 'S Ily r Ll a) Zip Phone <br /> � t7N <br /> Owner <br /> oLLqn, LS v-i � �"Ir <br /> 5 In21 <br /> L'+ Owner <br /> y yo to Applicant Melling Address CITY ZIP Phone <br /> Describe Proposed Work new SFR <br /> Protect Address(if known) Q L 5 <br /> Attach four(4)copies of plans for proposed work•Draw to scale and note the following as applicable: I— <br /> • property Lines • Centerline of street '^ <br /> • Outline and dimensions of all existing and • Inolcate North v, <br /> proposed structures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utilities • Show measurements `Y <br /> -50—NOT WRITE BELOW THIS LINE �ar� <br /> PERMIT CONDITIONS <br /> i 1.All calls for inspection shall be made 24 hrs.in advance•phone 259.8810. all <br /> ! 2.All work shall be performed In accordance with this permit and current City of Everett Design anr!Consiruction <br /> �+ Standards and Specifications. <br /> _ 3.Cell Location Underground Service 48 hra.before you dig TOLL FREE NUMBER 1.800.424.5555. <br /> 4. Install rock construction entrance behind driveway as par city <br /> standard 0208 and erosion control as directed by Public Works <br /> Tnapactor. <br /> 5. Keep city streets clean at all times <br /> 6. Curb gutter and sidewalk in the plat are new and undamaged, <br /> any damage thereto shall be replaced at the discretion of the <br /> Pub] i.c Works TnspectFSr. <br /> 7. Any change in the driveway cut, must be approved by the Publir. <br /> + Works Inspactor. <br /> 8. Tightline all roof, yard and driveway drains to storm drain <br /> stubs at back side of sidewalk. <br /> 9. Adjust water boxes to grade at end of construction. <br /> U 10. Driveways shall be completely cured before driving on them. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 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 /> If expenses, or causes of action that may arise because of Installation <br /> Cl Z, and maintenance of the Improvement or other right-of-way use hereto <br /> applied lot and further agrees to remove same upon notice from the <br /> Approved for Construction/ Dale City and to replace public properly damaged thereby. <br /> Fl,.." INSPECTION Date Signature of Appl'cant Date <br /> App,oved as Constructed <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 6'201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259.8810 PROJECT OVER 90 DAYS DURATION. <br />