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TYPE OR PRINT ONLV <br />" �'!15111Vt� <br />Apphtnl�on Fnr <br />PUBLIC WORKS PERMIT <br />PUBLIC W7RKS DEPARTMENT <br />5200 Cedar Slreel <br />Fverett, WA 98201 259-8810 <br />��STirir, o�T o 6 � <br />Da�e _ _ - 9-ZS-96 — / <br />Public Works Permit p ��r7�� __ __ <br />Building Pennit M . _ .53��2 <br />Public Works Fee $ � <br />Boraeth Conetruction 1241 S[ate Ave Maryeville 98270 3�9-1034 <br />Owner Mniling Address City Zip Phono <br />Todd Borseth <br />Applicant Mailing Address <br />Describe Proposed Work _new house_ <br />04/17/97 3:03FM ODOpH0850 #kKM <br />City Zip � Phone <br />q0005zoo2 <br />BLCG l792.i0 <br />- �&i- -�7Q:OQ- _ <br />MECri 560.00 <br />--SRCf#hi3 — SM1.3II--- <br />DRMI'1 f20.p0 <br />PROJECTADDRESS(ifknowr�) _ �11 93rd St SE Lot 4 Mt Vie��ilag�105.00 <br />---- ROfHI3[]g§,�-- <br />Attach lour (4) cc.pies ol plens 1or proposed work - Draw to scale end no�e Ihe following if applicable: r�� 570. � <br />•Prapeny Lines �Outlino and dimensions oi all eKisting end pmposed structure� on Ihe lot •Existing and pr�,1$�,Ltlli��96. �(1 <br />•Centedlne of street 'Indicale North •Show nny proposed greding changes •Show measuremenls ENDIII 5�33�.(� <br />1HIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in auvanco - phone 259-8810. <br />2. All worh shall be performed in accordance with lhis permit and current City of Everelt Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hr�. belore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />3/4- FiA<i/i�+�E��r w,Y/ 6c� ifornred o,�/� �+�r �ts� ys'-t�-�7 s"� fBbC� <br />67 f1tt, �v5/,al�or�t! G�e���rE�►�e.,t /xts {xC���h,�fu/lfJ��✓ 2eF�b�b rv��d,f <br />F r..�� rnc �hr�rt: rl:•�n nl rill hmr�� <br />� iuL rnll�i ;u�i� ,i�ieH:Jk w Uic �,In� :ne ncµ and uud�mr •cd. nin d,uir.r.. �h�ir��� .ie�!i 1�: i� pl,���J :�i <br />disciclion of:hc Public 1Vorks ln�p:ctar. <br />AAjnst w; �er boxes In n�;idr nt rnd ol cnnslnichnn <br />Uii�cw:qs ,liall bc eompl�lcn� eurcd bcforc du� in „ii ili:ui <br />R��Mop draina!��• �-hsll be dicchar�ed <br />In;> I-12 to en appiovcd inlilti,nion n:ncli <br />1.,I: 13-'I In Ih: dcrtu �6ainn��c .hi6 pia���.l�,d :�t ih.� ir:�i ,�I qi. lot <br />�' ' �. �, ' / �. � � I� / �i � �i � , � I/ // ' V � <br />! <br />� / i�. /� , /� -9 �' <br />l -, �'� -�!� y/>�-- <br />�vetl lor C sUuc�ion ��' , Dale <br />�3.Ke,� " 9--?�-9� <br />FINAL INSPECTION � Date <br />Approvetl as Const�ucted <br />fi^ <br />v/ <br />� <br />a <br />ACKNOWLfOGf.Nf-NT OF CONDITIONS <br />ihe unda�sign�tl nwnei!npphcanl herehy ayrees to hold and save hannless <br />Ihe Cdy Everelt Irom any and all d:ums tor damages, cosis, e�.penses �r <br />caus c�ion tpppat m y nrise because ol Installation and mainlenance ol <br />thei ment�o{lie�righbol-weyuseheretonppliedfornndluriherngrees <br />lo � ov a�e � otice from the Clty antl to replace public pwperty <br />Signalure <br />,\ <br />WORK AUTHORIZ[D BY THIS P[fiMIT MUST BE STARTFD WITHIN 190 DAVS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUE� TO <br />COMPLLTION THIS Pf RMIT M4V �[ CAt�CELLED OV TH[ CITV UPON ANV STOPPAGE OF WORK ON THIS PROJECT OVER BO DAVS DURATION. <br />