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/ - 8>r— i�3 <br /> Date � � PUEnc Worka Permit•/��!'��— <br /> Application For oiea oao�.• -��j �y� <br /> PUBLIC WORKS PERMIT °°°��°W°«°F°a <br /> Total Fea S <br /> Less RpD�Fea Paid S <br /> aa�e��a o�a s �-4a <br /> Print or Type Only �7a/9 <br /> Bovden Realtyy Inc. 1429 Broadway Everett 98201 252-1166 <br /> Ox•ner Mailing Address City Zip Phone <br /> J 6 D Builders 1429 Broadway Everett 98201 252-1166 <br /> Applicant Mailing Address City 2ip Phone <br /> Describe aroposed Work Single Family Residence <br /> W <br /> Pro�ectAddress(ilknown� 2`� — Drive 5 E. Everett � <br /> Attach four(4)copiee of plans for proposed wo�k- Draw to scale and no�e lhe following as applicable: � <br /> • Properly Lines • Centerline of sireet � <br /> • Outline and dimonsions oi all existing end • Indicate North <br /> proposed structures on the�ot • Show any p�oposed grading changes <br /> • Existing and proposed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LI�E O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•68�$. � <br /> 2. All work shall be performed in accordance with ihis permit and currenl City ol Everett Dssign and Construction <br /> StanAards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEUE�T O�CONDITIONS <br /> 1 <br /> � Thc undersigned ownedapplicant hereby agreec to hold and save harm� <br /> le:•s :he City of Everett from any and all claims foi cTmages, cosis, <br /> / J ex�enses, or causes of action ihat may arise because of installation <br /> /�� /�S and maintenance ol the improvement or other right-ol-way use hereto <br /> �?� Z�" `-' applied lor and luriher agrees to remove same upon notice Irom the <br /> ,� p r ed or C struction Date City and to replace public nroperry damaged thereby. <br /> � 7�23• Y3ro ��// '/ D <br /> FINAL INSPECTION Dale 2��iii.�i! �i� ��� r�A��. �o T 7 O S <br /> Approved as Constructed Signature ol Applican� Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 32COCetlarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS l'O <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITV UPON ANY STOPPAuE OF WORK ON THIS <br /> PROJ[CT OVER 90 DAYS DURATION. <br />