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// q/ � PubLc Worta Perm�l� <br /> 3 7 � ". <br /> Date� ��/�_��l — <br /> BI�O�DaO���— <br /> � Application For <br /> �UBLIC WORKS PERMIT '°°:o�aF�a°°a 5 �-° . �, ° <br /> LessAnC� �ee Pa�a $ <br /> PalancoDue $ •�O . U L� <br /> Print or Type Only �(�3�J <br /> Bo}den Realty, Inc. 1429 Broadway Ecer�tt 98201 252-1166 <br /> Owner MailingAddiess Ci•y Zip Phone <br /> Bo den Reale Inc. , dba J 6 D Builders, 1429 Broadwa , Everett, 98201 252-1166 <br /> Applicant Mailing Adtlress City Zip Phone <br /> Describe Proposed Vdork _Ncw Sin�.le Familv residence <br /> __ W <br /> Pro�ect Address(il known) z2i� 2nd Dr S C Everett - Prelimin�rv � <br /> Attach tour(4)copies ol plans for proposed work- Draw to scale and nole ihe lollowinp as applicable: �� <br /> • Properry Lines • Centerline ot street � <br /> • Ou�line and dimensions of all existing and • Indicate North <br /> propos�d siructures on the lot • Show any proposed gradinc�changes <br /> • Evi;tiny and proposed utilities • Show measwements M <br /> W <br /> ���i�"�'��0���� DO NOT WRITE BELOW THIS LINE O <br /> FERMIT CON�ITIONS <br /> 1. All calls lor inspecNon shall 6c made 24 hrs. m advance- phone 259•SB i 5. � <br /> 2. All work shall he perWrmed in accordance with this permlt and current Ciq� N Everetl Desi�n and Construction <br /> Standards and SpecilicaGons. � <br /> 3. Call Location Und^rpround Service 48 hrs. helorc you tlig.TOLL FREE NUMBER 1•800•424•5555. � r <br /> �. <br /> � C. <br /> �yyw � � <br /> �/ � <br /> Ot� r <br /> � C7 � <br /> � 6 F_ <br /> � ; <br /> n <br /> . <br /> `� ; <br /> ACKNOWLEDGEMENT OF GONDIT�ONS � : <br /> The undersigned owner/applicant hereby agrees to hold and save ha�m � : <br /> less Ihe Cily ot Everetl Irom any and all ctaims lor damages, �� s. , <br /> � expenses, or causes of action that may arise because of insta' � � U � <br /> /'� and maintenance of lhe improvement or other right-ol�way use � ' �� :' <br /> �%( �G"�-��---- �� z 2 �'S � applied for and iurther agrees to remove same upon notice Ir� <br /> Appwved fc�r s ruc ion ���e City and to replace public property damac�ed Ihereby. � ; � <br /> �./M" � �� � � , _ � _ r ' ' .. � <br /> � 1� �^ ' <br /> _-" ` �� " i�� / L!<�� � f� `_: . <br /> FINAL INSPECTION Date '- � �—"" " Date � � <br /> Approved as Constructed �SignaWre of Applicant � , <br /> W��RK AUTHORIZED 8Y THIS PERMIT MUSI BE STARTED WITHIN <br /> O������� PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO ' <br /> 3200 Cedar Slreel BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Everett,WA 98201 CHNCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-881 E pROJECT OVf_R 90 DAYS DUFATION. <br />