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Date ,�7 5 a�e���vo�es r�e,.m��i.�.�'�'' -� /'1—.� _ <br /> App!ica�ion For ��a�� oeoi.,1[.��q 5-7-- _ <br /> PUBLtC WORKS PERMIT �u�TalelFeere^ 5 <br /> Lass Apo4 Fea Pa�rJ 5_�S_t <br /> BalancrDue 5_ ���J���/ <br /> Print or Type Only -7� 9 9,9� <br /> Iloyden Realty, Inc. 1429 Broadway Everett 98201 252-1166 <br /> Owner Mailin9 AdCress Ciry Zip Phonc <br /> J & D Builders 1429 IIroadway Everett 98201 252-11G6 <br /> Applicant Mailin9 Address City Zip Phone <br /> z <br /> 0 <br /> -i <br /> Describe Proposetl Work New Single FamilY Residenc^_ � <br /> m <br /> .. .. <br /> — � � <br /> _ � ~ -i <br /> V1 2 <br /> — � rn <br /> ProjectAOdress�ifknown� 9412 - 1�Driv- S.F._ _i_.ye;._.rt co <br /> mo <br /> Attach lour(4)copies ot plans lor proposed worii- Drav:to sca�e and nute Ihe lollowing as applica6le: � � � <br /> • Properry Lines • Centedine of sireet � ' <br /> • Outline and dimansions ot all existing and • Indicate Nerih --i z <br /> proposed slruclures on the lot • Show any proposed grading chan9es m~ <br /> • Exisling and proposed utilities • Show measuremento M q z <br /> W = <br /> DO NOT WRITE BELOW THIS LINE r ? <br /> PERMIT CONDIilONS O j N <br /> 1. All calls lor inspection sha!I be made 2n hrs. in advance� phone 259•881 5. � �n <br /> 2. All work shell be pertormetl in accortlance with this permit and r,wrent Ciry of Everett Design and Construction — <br /> Standards and Specifications. '"��" <br /> 3. Call Locetion Underc�iound Service 48 hrs. before�ou dig.TOLI_FREE NUMBER 1•$00•4^c4•5555. � _ <br /> m �- <br /> V <br /> or <br /> O c� m <br /> C N <br /> m� <br /> z c� <br /> � �m <br /> a <br /> � <br /> Y/ � <br /> a <br /> � -T <br /> a � <br /> � <br /> -i <br /> n <br /> m <br /> ACKN��WLLDGEIdENT OF CONDITIONS <br /> The undcrsigned owner,'applicant hereby ayrces to hold and save harm� <br /> - less Ihe City ol Everett fwm any and all claims tor damzges. cosis, <br /> ' expenses, or causes ol aclion lhat may arise her.ause ol installation <br /> � � _ `�' / / -�L;3.�� a�d maintenance of �h � improvement or other ri9hl�ol�way use hereto <br /> '' � applied for and lurther agrees to rem,we same upon notice irom the <br /> Approved for Con t ction Date City and to replace public property damaged thereby. <br /> �'(1 ����— /���c,�.,— C.- / �� CO/.����_ <br /> FINAL INSPE TION Date <br /> Approved as Consiructed Si-�ure ol Applic�nt D�te <br /> WORK AUTHORIZED FY THIS PFRMIT MUST BE STARTED WITHIN <br /> i.�..�i.�� PUBLIC WORKS DEPrRTMENT 180 DAVS Of �ATE :cRM191T IS ISSUEO AND THEREHFTER IS TO <br /> � �2C0 Cedar Street BE DILIGFNTLY PURSUED TO COM�LETION. THIS PERMIT MAY BE <br /> C-veretL WA 98201 C,�NCELLED 81'THE CITY UPON ANY 3TOPPAGE OF WORK ON THIS <br /> Phonc: 2E'3�3915 PFOJLCT OVER ilq DAYS UURATION. <br />