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Date �y Ps �yn �'/ <br /> �J Puo�k woas Permu•�`"�S" � � <br /> App�icatlon Por eiee�oao�., �l�/ /} ,LOG <br /> PUBLIC WORKS PERMIT PuetoialFoaFae s <br /> Lass Ap01.Fea PaiE S <br /> Print or Type Only Baiancc Duo s z�OZ' _ <br /> 79a// <br /> iloyden Realty, Inc. 1429 Broadway Everett 98201 252-1166 <br /> Owner Mai{in9 Address Ciry 2ip Phone <br /> J & D Builders 1429 Broadway Everett 98201 252-1166 <br /> Apphcant MaJing Atldress City Zip Phone <br /> Describe Proposed Work Single Family Residence <br /> W <br /> ProlectAd�'ress�ifknown) 9322 - let Drive S.E. Evetett � <br /> Attach four(9)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • ?roperty Lines • Cenlerline of sireet � <br /> • (lutline and dimensions of all e<istinq and • Indicate North <br /> oroposed structures on the lot • Show any proposed grading changes <br /> • :xisting and proposed utilities • Show measurements � <br /> DO�'OT Wq�TE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cails lor inspection shall be made 24 hrs.in advance-phone 259•88�S. � <br /> 2. All work shall be parformed in accordance with this permit and current City ol Everett Desiqn and Consiruction <br /> Standards and Specifications <br /> 3. Call Location UndergrounG Service 48 hrs. beto�e you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> �w <br /> _/ <br /> � <br /> �: <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undcrsigned owner/app�icant hereby agrees to hold snd save harm� <br /> I �ess Ihe City ol Everett Irom any and all claims for Camages, costs, <br /> expenses or causes of action Ihat may arise because of inslallation <br /> �— �' / � and maintenance cf the improvement or other righl�ol�way use hereto <br /> 2G� �Glcr�j`� 7'-��S applied lor and lurther agrees to remove same upon notice Iwm the <br /> Approved lor Construction Date City and to replace public property damaged thereby. <br /> / <br /> n ,�. �-z�.� , . .- G_ <br /> FINALINSPECTION Date �� L %«�^� " �- ��•v j ' <br /> App•oved as Constructed ` '/( / � �/ <br /> Signature ol Applicant / Oale <br /> everett 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 70 <br /> Everett,WA 98201 BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WO'?K ON TF'IS <br /> PROJECT OVER 90 DAYS DJRATION. <br />