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�v �LS <br /> PuElw k'o�wr Perma• / � <br /> Date y � i BIEQ Dept�-8_.Y <br /> Applicelion For �� �`� <br /> PE R M IT P"°"`""°"'F`° 5 <br /> PUBLIC WORKS TotaiFee �� <br /> �ess Aoo�Fee Psia S �, U Q <br /> 9:IanceDue s <br /> Print or Typ'� Oniy � ��97� <br /> Gverett 98201 252-1166 <br /> Boyden Realt , Inc. 1429 Broadwa C.'Y Z�p Phone <br /> Owner Mailing Address <br /> Boyden Realty, Inc. Everett 98201 252-].166 <br /> dba J 6 D Builders 1429 Broadway CI`Y Z�p pnone <br /> ppplicant Mailing Address <br /> Describ�: Proposed Work "tew Sin le Famil Reside e — <br /> � <br /> Prolecl Address(il know�l 9419 2nd Dii S F Ever J � <br /> Atlach lour(4) copies ol plans lor proposed wo�k• DraN�to scale antl note�Ceniterline of I�eei;able: � <br /> • Property Lines • Indicale North <br /> • Outli�e and dimensions ol all ezisling and � Show 2ny proposed grading changes � <br /> proposed siructures on the lot � Show measuremenis <br /> • Existing and proposed utilities <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls tor inspection shall be m�?e 24 hrs. in advance� phone 259-881 5. � <br /> 2. All work shell be perlormed in accordance with this permit and current City ol Everett Design and Conslruction Z <br /> Standards and Specitications. � � <br /> 3. Call Location Underground Service 48 hrs. before you dig,TOLL FREE NUMBER 1•800-424-5555. _ <br /> r. <br /> O �� <br /> N H " <br /> H � <br /> � N r <br /> O C� <br /> � � F, <br /> J � <br /> � ' <br /> F <br /> � . <br /> ACKNOWI-EOGEtdENT OF CONDITIONS y '. <br /> Tlie undersigned owaer/aPPlicaM hereby ag <br /> rees to hold and save harm� H � <br /> less the Cit/ of Everett irom any and all claims for damages, costs. K b <br /> expenses. or causes ol action 0'�at may arise because ol inslallation O ; <br /> � .� /F �y and maintenance of the improvement or other right-obway use hereto L, <br /> applied lor and lurther agrees lo remove same upon no!ice Irom ihe <br /> Date City and to rep��ce public property damaAed thereby. � c, <br /> prov• .:^pV� nstt tian— \ � <br /> � �/� lZ - �� �' /c��- y-1°-S.y 1 . <br /> � DTte� � �'`'~ Date � �.� <br /> F I N A L I N S P E C T I O S i gnature ot ApPlicant � , <br /> Approved asConstruU�ed �yOFiK AUTHORIZ'eD BY THIS PERMIT MUST BE STAR T E D W I T H I M � ., <br /> everett PUBUC WORKS DEF:\RTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTC-R IS TO - '� <br /> � 3200 Cedar Sireet BE DILIGEN fLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> E�arMC WP.98207 pROJECT OVBR 90 UA S DURAT pN.STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 <br />