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Date,�f�1�/h. � <br />Applicetlon For <br />PU@LIC WORKS PERMIT <br />Print or Type Only <br />Realty, Ii,c. 1429 Aroadway <br />Everett <br />i'uEl c Wark� Parnl� • ��� � O� <br />BIaO Oeo1 • <br />PUE�¢ wa.ks Fes <br />fol�l Fsa � _ � • �� � <br />Le�e �DP� Fss P�iC i <br />B�ienceDue S ��''V.On <br />98201 252-1166 <br />Z�P Phane <br />Boyden Realty, Inc., dba J b D Bulldere, 1429 Btoadway, Everett 98201 252-1166 <br />Appllcent MeilingAddrees City Zip Phone <br />DescrlGe Proposed Wo�k New ein¢le fnmilv residence <br />Pro�ect Addreee (It kncwn� <br />Altech lour (4) copies ol p�ens �or proposed work • Draw lo ecele end notn the lollowing es applicable: <br />• Property Lines <br />� Outline erd dimenslone ol all axioting end <br />proposed struclures on the lot <br />• Exleting and proposed utiiitlea <br />PERMIT CONDITIONS <br />• Centerline al sireet <br />• �ndicate North <br />• Show any proposad grading chenges <br />• Show meosurema�ts <br />1. All calls for inapec�ion shell be madN 24 hrs in ativenca • phonc 259•8815. <br />2. All work ehall be parlormed In eccoraance w.�h Ihis permll and current City of Everett Gesign and Construction <br />Stenderde end Specificeflona. <br />3. Celi Location Undergrn�nd Service 4B his. b�fore you dig. �TOI l FREE NUMBER 1•800•424•5555. <br />�� ,%Y(�-- /� � z ' F� <br />�prOved for C atruCtlon Date <br />� I <br />QQ �; � <br />FINAL INSPECTION Dale <br />Approved ea Conslructed <br />evereC � PUBLIC WORKS DEPARTMENT <br />� 3200 Cedai Sfreet <br />Evarett, WA 98201 <br />Phone: 259�8815 <br />ACKNUWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undereignp.d owneVapplir,ent horehy egrees to hold entl aeve herm- <br />less tho �ity ol Evr,�e�l Irom any and ell clelms lor Aemages, Costs, <br />e+pa�ses. or causes al ection that mey erisa because ol Inetellntion <br />end malm��.nence of the improvement or uther rlght-ol-way use hereto <br />applied fo� and further e�reer. to remova seme upon notice Irom Ihe <br />City antl to repl�ce public prope•ty dameged thereby. <br />� �._ ;c . . _ i�_, ?'� ' �. '.4:1 <br />Siqnatura ol App�icanl <br />OBte <br />WORK AUTHOR12ED BV THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />�E DILIGENTLY PUftSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 00 OAVS DU7ATION. <br />