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DateLL.71�s <br />Applicallon For <br />PUBLIC WOR�CS PERMIT <br />Print or Type Only <br />�� _ ��u- <br />PubLc Wo�he Vnrmil • � � L' <br />B�a�. Deo� � � � � <br />PUE1�c Wa�Mf fee s <br />To1al iee <br />Leu �pP� fee P�id S / <br />Bel�nce oue S � O� "!�' <br />7y,2 a3 <br />Bovden Realtv. Inc. 1429 Broadway Everett 98201 252-1166 <br />Owne� MelNng Addreas Clly Zip Phone <br />J S D Buildere 1429 Broadway Everett 98201 252-1166 <br />Applicant Malling Addrese Cily ZiF Phone <br />Describe Propoaed Work Single Family Reeidence <br />P�o�ectAddreeall�known) 219 — 94th Street S.E. _ ___ <br />Attech lour (4) copies ol plans lor proposed work - Draw ta acale and note the lollowing es applicable: <br />• P .perty Llnes <br />• Oultine end dlmensions ot all exiating and <br />propoaed structures on tha lot <br />� Eziatlnp and proposad utlllties <br />• Centedine al sVeet <br />• Indica�e North <br />• Show any proposed gradinB changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cella lor Inspecf.on ahell be made 24 hra. in advance - phor�e 259•BS1 5. <br />2. All work shall 6e pe�lormed in eccmdance with ihis permit and cuneM City of Everoll Deslgn end Conslruc�lon <br />3�antlards and Specllicetiona <br />3. Call Location Unde�ground Service 49 hrs. beto�� you Aig. TOLL FREE NUMBER 1•BOO•4'14•5555. <br />� � U: <br />f ���� �«��.,. /�,. a_; <br />Approved lor Cons�rucifon i-Date <br />� . t��./� N-1 ?.� 7� L �1 _ <br />FINAL INSPECTION - �� <br />Approved es Conslructed <br />evcrett PUBLiC WORKS DEPARTMENi <br />� 3200 Cedar Streel <br />Everelt. WA 98201 <br />Phone:259 8815 <br />�CKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />O <br />a <br />Thr, undersiyned owner/applicant he�eby agrees m hold and savo harm� <br />less the Gty of Everett Irom any and all cla�ms for damages, cosls. <br />e.perises, or causes of action Ihat mpy arise becnuse ol installation <br />�nd maintent ncr ot Ihe improvomenl or uther righPof-way use hereto <br />apphed lor and lurther egrees �o remove same upon notice Irom the <br />City and to replace public properry demeged thereby. <br />I4�' . �/ .. / -/ <br />�� �... , y_. � . :' l_ o, / .S S \- S <br />� <br />Signature uf Applicant ^ ��Dete <br />WORK AUTHORIZED BV THI i PERMIT MUST 8E STARTED WITHIN <br />1B0 DAYS OF DATE PCRMI' IS ISSUED AND THEPEAFTEF IS TO <br />BE DILIG[NTLV PURSUEII ?O COMPLETION. THIS PERMIT MAV BE <br />CANC[LL[D �Y THE CITY l PON ANV STOPPAGE OF WORK ON THIS <br />PROJ[CT OVER 90 DAVG DURATION. <br />