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i <br />Date/? �� <br />Apphcatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />83 3/y <br />Pup��. Wor�e Pe�mit • — <br />�i. �-"_ <br />Pinu Onn� � _ —�—�--- <br />v�io �c worw� fee s�a.�Q � Lr7 J <br />tolnl Fee � <br />lneeno0l FeaPertl S — <br />9,im�e oue 6 i� ' Q�p <br />IIovden Realtv. Inc.. �429 Aroadwav__ v r tt 9F3201 25?-�1.� <br />Owner Mailing Addreas City Zip Phone <br />Boyden AealtV Inc. dix� J& D Puilders, 1429 BroadNav Everatt 98201 252-11G6 _ <br />Applicent Meiling Address Cily Lp Phone <br />Daecri6e Proposed Work _ NeW Sinale ['amilv itesidence _ <br />2C? - 96th T"��= �:-F'- <br />Prolect Address (if known) --- <br />Altach lour 14) copies ol plens lor proposed work � D�nw lo scale and note ihe lollcwing as aupl�cac��r� <br />• Properly lines <br />• Outline end dimenslons ol ell evisting nnd <br />proposed s�ructures on the lot <br />• Exisling end proposed ulilities <br />• Cenlerline oi she��J <br />• Indicete Norlh <br />• Show Bny proposeU 9rodrn9 chan9es <br />• Show measurnments <br />PERMIT CONDITIUNS <br />1. All calls lor inspection shall be madn 24 hrs. in aAvancr � nhono 259•BH1 5. <br />2 All work shell be perlo�med In nccordence wdh Ihis pe�mit and current City of Everetl Design anA Constru��.tion <br />5�andards nnd Specilicatlons <br />3. Calt Locnlion Under9round Service 40 hrs. belore 1nu diy lC.:_ FFEE NUMBER 1•80C•420-$55.�i. <br />-� f""" ' �� �/lc!{.�i--- - �� -is" � d3 <br />AU o� nstr ian —�-- ���� <br />_ _. ��� ' <br />FINAL INSPECTIGN DaiA <br />Approved as Constructed <br />�.�,r���.�� �UBIIC WOFKS D RTMENT <br />� �200 Cedai Siree� <br />Everett. W� 09101 <br />19�cnc 259�901!, <br />AGKNOVJLf_DGEMENf OF GONDITIONS <br />� <br />O <br />� <br />� <br />O <br />Tl:e undersiyn�d owneyepplicant hereby ag�ees to hold end snve harm� <br />less Ihe City of Fverett hom nny and all claims lor damegos, cosls, <br />eMfonses, or causes ol action Ihat may arise becouse ol installalion <br />anA maintenence of tha imG�o�ement or other riphbol-way use he�e�o <br />applieA for end lurlher agrces to iemovr. samx upon notice Irom Ihe <br />Ctly und lo replace p�blic proporry oamaged theiebj <br />/. ' <br />� � � <br />. t:. � L � � . <br />/ c . - .. —�" � . fls,.�r <br />SignaWreo�Applicant , �ato <br />WORK AUTIIORR[D BV TH{5 PERMIT A1UST BE STARTED WITHIN <br />180 DAVS OF �ATE PERMIT IS ISSUED �ND THER�AFTER IS TO <br />FiE DIUGENTLV PURSUED TO COG1f`L C1101J TI��I ; PG7MI7 1dAv F,[� <br />.;PNCELLED BV THE GI7Y UPON AN� s�Ot'P�Gf Of WG!a1( (�I! 1' <br />f'HOJf�.CT OA'fli 40 D�Y; f]UNATIOla <br />� <br />� <br />t. <br />