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Applicetlon For <br />PUBLIC WORKS PERM�T <br />Print or Type Only <br />Pupl¢ WorM� PetrmN r� v 5� �� � <br />BIEp. Deot. � ._d.Z � •��%.S? <br />PUGhc Worb Faa <br />Tm�IFee � <br />lau �DG� Fe� PUE S . <br />B�I�nceDue S �� �� <br />78�%s <br />Soyden Realty, Inc. 1429 Broadway Everett 98201 252-116G <br />Owner Meiling Address Cily Zip phone <br />,T 6 D Buildere <br />1429 Hroadwey <br />Malling Addreae <br />Deealbe Proposetl Wo�k Single Family Residence <br />ProlectAddresa�llknown) 125 - 94th Street S.E. <br />Everett 98201 <br />Clty <br />Atlach lour (4) copies ol p�ena lor proposetl work - D�aw to ecele and nofe the lollowing as applicable: <br />• Property linea <br />� Outlina anA dlmensions ol all existing end <br />propoaed etructures on the lot <br />• Existing end propoeed utllitles <br />PERMIT CONDITIONS <br />252-1166 <br />Phone <br />� Conterllne of street <br />• Indicate North <br />• Show eny proposed grading chenges <br />� Show meaaurements <br />1. All calls Ior Inspaction ahell be mede 24 hrs in edvance � phone 259•881 5. <br />2. All work shatl be performad In accordance with thle permit end cwrent City ol Fverec Uesign a��d Construclion <br />Stendards and Speciflcatlons <br />3. Cell Location Undergr� und Service 48 hrs. belora yc� dig. TOLL FREE NUMBER 1•P}00•4.i4•5555. <br />/��' ) � <br />r_ " �/�JOt+�s�_.. / t'.� ' �il' � <br />Approved for ConstrucUc, Date <br />1 ` <br />�e.�-� 'j —�•� (o <br />FINAL INSPECTIO Date <br />Approved es Constructed <br />everett PUBLIC WORKS OEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 88201 <br />Phone: 259•BB7 5 <br />ACKNOWi.EDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />The untlersianed owner/npplicant heroby agrees to hold and aave hnrm• <br />less Ihe Cdy of Everett from any and all claims lor damages, costs, <br />ezpenses. �r causes ol action that may arise because ol inslallation <br />and maintenance oi the Improvement or olhar rlght-ol�way use here�� <br />applied for and fur�her egrees to remove same upon notice 1rom the <br />City and to repinco public prope�ty demaged thereby. <br />�. � <br />/�;���-,._- �: j ,_ i ' `� ,S � <br />Signatwe of ApplicaM �^ � � <br />WORK AUl"HORI2ED BY THIS PERMIT MUST 8E STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS nURATION. <br />