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Date�S <br />Appllcetlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PUEI�c WorM� Psrmlf �S— 235 <br />aiaa oeo�. • 8'��S/.S� <br />PuOik Worb Fee <br />Totel Fee � <br />1.eu �oG� Fee P�itl s__ __ <br />B�I�nca Ow { 2� �U <br />Soyden Realty, Inc. 1429 BroadWny Everett 98201 252-1166 <br />Owner Melllnp Add�ess City Zip Phone <br />J 6 D Buildere 1429 Sroadway Everett 98201 252-1166 <br />Applicant MailinpAddresa City 2ip Phone <br />Deacribe Propoeed Wo�k New Single Fnmily Reeidence <br />P�o�ect Addrese pl known) 1Z6 — <br />Atte:h lour (4) coplee ol plene lor propoeed wOrk • Draw to aCele and note the Ioilowing as apDlicable: <br />• Property Lines • Centerline ol st�eet <br />• Outline end dlmenslona ol all existing end • Intlicate North <br />propoaed struclurea on the lot • Show any proposetl grading chenges <br />• Exleting end proposed utilitlea • Show meesurements <br />Approvedim <br />PERMIT CONDITIONS <br />' All calis for Inepection shell be mede 24 hrs In edvence • phone 259•8815. <br />2. All work ahell be perlormed In accordence with Ihis permil and cunent Clty of Everett DesiBn end Construction <br />Stenderds and Spaciflcetlona. <br />3. Cell Locatlon Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� �'3 -,� S <br />Dele <br />_t,nn� Y � ! 1 �27 �[SS <br />FINAL INSPECTION Dele <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Siroel <br />Everetl, WA 98201 <br />Phone: 259•8815 <br />'ldit �% <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owne�/applicnnt he�eby egrees lo holtl and save harm• <br />less the CI!y ol Evare�l Irom eny and all claims for damages, costs, <br />expenses, or cauaes ol action thal may arise because ol Inelellation <br />end mainlanance o! the improvemen� or olher right-ol�way use hereto <br />applied lor and furthe� �grees to remove same upon nolice from �he <br />City and tc replace public properry damagad thereby. <br />� � <br />/(. ��'�`�..— �� � ���".%` ��i'Y/ffj— <br />Signature of Applicanl ate <br />WORK AUTHO(71ZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />