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Date �• 1•F Pe�i¢Woan Permlt� � / z I <br /> Application Fcr 9�ec�oeo�..___ <br /> PUBLIC WORKS PE�i111T PoblicWorknFee > <br /> To1al Fae �—C�� � J <br /> 1e55 A00�F!a PoiO S <br /> Bebaae�ue S��• U �' <br /> Print or Type Only /� �U�p <br /> yG / <br /> Boyden Realty, Inc. 1429 Broadwav Everett 98201 252-1166 <br /> Owner Mailing Address Cily ZiP Phone <br /> Boyden Realty, Inc dba .I 6 D Builders 1429 Broadway Everett 98201 252-]166 <br /> Applicant Mailing Address Cl;y Zip Phon <br /> Describe Proposed Work _ New Single Family Residence <br /> W <br /> Projec!Address(itknown) _. 9414 - 9nd nri C R_ F .nr�rr _ � <br /> Attach tour(4) copies of plans for proposed work- Draw to scale and nofe the lollowing as applicable: � <br /> • Property Lines • Centerline of street ♦A <br /> • Outline and dimonsions ol all existing and • Indicate North V� <br /> proposed sirucl�res on the lot • Show any p�oposed gradirg changec <br /> • Exisling and�ioposed utilities • Show measurements /� <br /> W <br /> , .. DC NOT WRITE BEIOW THIS LINE O <br /> PERA�IT CONDITION,�'i <br /> 1. Ail calis for inspection shell 6e made 24 hr= !n advance-phone 259•881 5. � <br /> 2. All work shall 6e performed in accordance with this permit ano current C�ly of Everett Des�yn and Construction � <br /> Standnrds�ntl Specifications. `� <br /> 3. Call Loca!ion UnCr.ryround Serv'ce 48 hrs.berore you Aig.TOLL FREE NUMBER 1-800•424•5555. � �_ <br /> r <br /> � <br /> � ~ ~ <br /> -� � <br /> Y/ H � <br /> ,� _. <br /> J �' <br /> � � �' <br /> � � I� <br /> � : <br /> C <br /> +. . <br /> ACKtJOWLEDGEMENTOFCONDITIONS a ,��1' <br /> The undersigned owner/applicant hereby agrees to hold and save harm- " a <br /> - less Ihe City ot Everett irom any and ail claims for damages, cosis, � <br /> � eapenses. or causes ol action that may arise because ol installation � <br /> �` f and main�enance ol the improvement or other rioh4of�way use hereto � <br /> i l��� ' �� � - applied lor and further agrees to remcve same upon notice Irom the <br /> ppr�o ed�or Consiruct� Uate City and to replace public property aamaged Ihereby. � � <br /> . � � <br /> (�'� J r <br /> FINAL NSf'ECTION I �'� Date � `-'�""'"`�- �" �''���- y �f� f � � <br /> Approved as Consiructed\ iignature ol Applicant Date <br /> WORK AUTHORIZED BY THIS PI:RMIT MUST BE STARTED WITNIN <br /> everelt PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO f.OMPLETION. TNIS 'ERMIT MAY 9E <br /> Everetl,WA Pt�207 CANCELLED BY THE CITY UP('N ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259�dB15 PROJcCT OVER 90 DAYS DUAATION. <br />