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Date��3 <br />Applicallon For <br />PUBI_IC WORKS PERMIT <br />Print or Tyoe Only <br />Punlic Wark� Permil • ��� p�q/ � <br />Blap. Deol � �2�_�sL_ — <br />vubllcWork�Fn S �,� U O <br />Tal�l Fee <br />LefnROP<<eeVUJ i__ <br />B�iance �ue i � � � � <br />Gn�6 3 9 <br />Bovden Realtv, iac. 1429 BroadwaY Everett 98201 252-1166 <br />Owner Mellinp Address City . Zip Fhone <br />�y�� n�i+X, r.,� „ dba T R D Ai�ildars 1429 Broadxay. Everett 98201 252-1166 <br />Appllcant Melling Address City ZIp Phone <br />Destribe Proposed Work New sinal? familv residence <br />Pro�ect Address (if known) <br />Attech lour (4) coples ol plans lor proposed work • Drew to scele enA nota the lollowing as applicable: <br />• P�operty Linea • Centerline of sheel <br />• Outline end dimennlons ol ell exlating end • Indicale Nor1h <br />proposed �tructu�es on the lot • Show any proposad gredin� changes <br />• Existing end proposed ulilitles • Show moasuramanls <br />PERMIT COND;TIONS <br />1. All cells lor Inspaclion vhell 6e made 24 hrs. In advonce • phone 2S9•881 b. <br />2. All work ehall be perlormed in accordance wilh �his permlt and current Ciry ol Eveiatl Oesign and Cons�ruction <br />Stenderds ond Speclflcalions. <br />3. Cell Low�ion Untlarground Service 48 hre. before you dlg. TOLL FREE NUMBER 1•800•424•5555. <br />�or <br />FINAL INSPECTION /� <br />Approved es Constiucte <br />everelt PUBUC WORKS DEPARIMENT <br />� 3200 Cedar Sireet <br />Eve�etl, WA 98201 <br />PhonB: 259�8815 <br />�r•F <br />Dnle <br />Dn�e <br />ACKNGWLEDG�MENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />� <br />a <br />a <br />The undersigned owneUapplicant hereby agrees to hold and save hanm <br />less ihe : ity ol Everetl Irom any and all claims lor demages, costs, <br />expenses, or ceuses ol action that mey erise beceuse ol In6tnitalinn <br />And meintenence of the improvement or othe� right�of-wey use hereto <br />npplied far antl lurther egreea to remova seme upon notice Irom the <br />City end �o replace public property dameped thereby. <br />"`.-. , `_-, � �- �L '.- .t�-..t <br />/ _ _ :... ��-r- <br />Signature ol Applicent Dete <br />WORK AUTHORIZEU BV THIS PFHMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEN IS TO <br />BE DILIGF.NTLY PURSUED TO COMPLETION. TF'IS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPACE OF WORK ON THIF <br />PROJECT OVER 90 DAYS DURATION. <br />