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Dete:��,[.�.�� wer�wo�k.v.,mu. 8..��-/�i�Cg <br /> Application For eieu.oao�.e�.S��y�s3 <br /> PUBLIC WORKS PERMIT P�o��Wo�k.Fe. <br /> TotH Fea � <br /> Leas ApPI.F!!P�IE s �y� <br /> Print or Type Only Balan�eDue S 2�/V// <br /> B�den Real[y, Inc._ 1429 Broadway Everett 98201 252-1166 <br /> Owner Mailing Addr.,ss Cily Zip Phone <br /> J & A Builders 1429 Broadway Everett 98201 252-1166 <br /> Applicent MailingAddress City Zip Phone <br /> Describe Propoeed Work New SinQle Family Residence <br /> ProlectAddress�itknown) 9411 - ls[ Drive S.E. Everett � <br /> Attach four(4)copies of plans for proposed work• Draw to;�:ale and note the lollowing as��pplicable: � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed gra�ing changes <br /> • Existing and proposed utilitie� • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERM�T COIJDITIOVS O <br /> 1. All cells for inspection shall be inade 24 hrs. in advance• phone 259•881 S. � <br /> '. All work shall be performed in accordance with this permit and current Ci�y ol Everet!Design and Conslruction <br /> Standards 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 /> �CKNOWLEOGEMENT OF CONDITIONS � <br /> The undersi9neA owner/applicant hereby agrees to hold and save harm� <br /> �_�- less ihe City ol Everett Irom any and all claims lor damages, r.osts, <br /> expenses, or causes ol action that may arise because ol installation <br /> ,(� �/��- s/��/�f` and maintenarce ol Ihe improvement or other ri�ht•ol•�Nay use herelo <br /> �I�Approve applied lor and lurther agrees lo remove same upon notice Irom Ihe <br /> odstruoYon/ � Date City and to replace pubiic property damaged thereby. <br /> � `� ( Q�� �7� / <br /> FINAL INSPECTION Date 5-�rl���-�"l'� ���G--�A� .,3/�(y�� <br /> Approved as Consiructed Signature ol Applica �� Date <br /> everett PUBL�C WORKS DtPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br /> Everett,WA 98201 BE DILIGFN7LY PUFSUED TO COMPLETION. THIS PERMI�� MAY BE <br /> Phone:259•8815 CANCELLED DY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJErT OVER 90 DAYS DURATION. <br />