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�8te_� PUEIicWorbPsrmit• �+ J� /�� <br /> Application For BIEy.Deo�.�.�f �87 <br /> PUBLIC WORKS PERMIT P°°To,:FeeFea s <br /> leu AppL Fae PaiE f <br /> B�lance�ue S ���� <br /> Print or Type Only <br /> �3s8' <br /> Boyden Realty, Inc. 1429 Broadway Everett 98201 252-1166 <br /> Owner Mailing Address City Zip Phone <br /> J 6 D Builders 1429 i;roadwav Everett 98201 252-1166 <br /> Applicant Mailing Address City 2ip Phone <br /> Describe Proposed Work New Singi� Family Residence <br /> 9Un,.� W <br /> P�o�ectAddress(ifknown) `�8" lst Drive S.E. , Everett � <br /> Attaeh lour(4)copies of planc foi proposed work• Draw to scale and note the following as applicable: � <br /> � Property Linas • CeNerline ol street � <br /> • Outline and itimensions of all ezisting and • Indicate Norih <br /> proposetl structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City ol Everetl Design and Consiruction <br /> Standerds end 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 /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> — less the City ol Everelt irom any and all claims for dameges, costs. <br /> , . �� <br /> %� expenses, or causes of action that may arise because of insta ation <br /> � � and maintenance of ihe ir.nprovement or other right�ol�way use hereto <br /> -^ r- -- � � '" �- �� applied for and lurther agrees lo remove same upon nolice irom Ihe <br /> Appro� d lor Co(�structi n , Date City antl to replace public properry dameged iherehy. <br /> ZUZ�II .C/GYnL! �/J' .�J����. 2f�`O/S <br /> FINAL INSPECTION � �e �/ �` <br /> Approved as Consiructed Signature ot Applic t Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST 8E STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32Q0 Cedar Streel BE DILIGENTLV PURSUED TO COMPLETION. THIS FERMIT MAY BE <br /> � Everett,WA 98201 CANCELLED OY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURATION. <br />