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Date_��i}�G' <br />Applic�tion FOr <br />PUBLIC WflRKS PERMIT <br />Prinl or Type Only <br />�,i•. Wnnsl'wrm(�n• 4i!' � ���_ <br />r �in n.n� • _1J-�-� / G a .� ,F___ <br />7 <br />i�um�r WmM i�e ----- _�—_� <br />Lr�e� fee ` <br />Ies;ApplfleP:�ds_ '�`— <br />Onnnc< �ue S �' J <br />Hovden Realty. Inc�_�42Q Bruadwav Everett 98201 252-1166 _ _____ <br />Owner Meiling AtlAress Gly 2ip Phone <br />J 6 D Buildere 1429 Broadway Everett 98201 _ 252-116G <br />qppl2ant Mailing AAdress Cily 2ip Phone <br />D��a�oe Pmpc�ecd Work New Sinqle Familv Residence _ <br />w <br />ProlectAddresslifknown� 204 - 97th Place S,E•,.�yCiELt��-QZ9i_ _ <br />Allach tour I41 copie� ol plens for p�oposed work - Drew lo sr.ale n�A nMe the lolloKing a� �pP��cnl�lr <br />• Property Lmes <br />• Oullino and dimenslo�� ol all exishnq antl <br />proposad SUuc�ores on Ihe lot <br />• EMi9tin{I antl proposed ulihties <br />PERMIT (:ONDITIONS <br />• Center6ne al Ureet <br />• Indir.ate North <br />• Show Pny proposed gmdmq rh.�nqos <br />• ShOw nu�aswPmen�s <br />t. All cnlle lo� inspeclion shell be maAe 24 hr.; m nAvaoce � phune 259•881 5 <br />2. All wo�4 shell be perlormed m nccorAance wi�h ihis permd and r.u���nl Ci�y ol E vorett Desiqr and Conslruclion <br />Stenderds end Specil�celions <br />9 Gall Lotallon Underground Service 4B hrs. 6elore you di8 TOLL FRFE N�JMBER i•BOO•424•5555. <br />4. ANY GktADING DONE ON THIS LAT SHAL4 BE DONE SO AS NOT TO IMPACT THE <br />SURROONDING IATS WITH RAINWATF.R RUIJOFF. <br />5, ANY CURB & GUTTER OR �IDEWALK DAMAGED DUNING CONSTRUCTION SI�Ai.L BE <br />REPLACED B� THE APPLICANT. <br />_'- � ,� y ,��: <br />�� - s�— � <br />Approvetl f0i Cons uCiion a�C <br />i <br />� % <br />FINAL INSPECTION Date <br />Approv�d as ConsnuclrA <br />�.��.��q� PUBLIC WORKS DEPARTMENI <br />� 3200 Gedar S�reel <br />Fv�r��ti 'NA 4R9f1 <br />�`hi � `�q.liPl!i <br />nCkNOWLEDGLMLNT O� GONDI�IONS <br />W <br />H <br />aw�l <br />w I <br />� <br />U <br />`hn vnib•isiynrd uWnef{�pPhCBnI herel�y Apree5lG I�nl,l nnn �,;�vr h,nni- <br />i,�ss �he Gdy ol [verell Iwm nny and all r.laims Im dam�yns �.osls <br />nzpen5es w causes ol action �hat may anse becnuse ol mslallatron <br />,anA mamlenanre ol ihe improvernent �r olher righl�ol�way use hereto <br />Ppphed la� nntl IWlher q3rP.e5 la romove seme upOn nolice hom Ihe <br />Cily nnA to �epla[P public property dam9ped �hereby <br />� i <br />i <br />.-� � I�� 1•l� CC..— / C ` '� (�'� , - _' <br />ignalure ol Appl�canl �5���' <br />WORh AUTNORIZED BV �'HIS PEHMIT MUST 8E £TARTED WITHiN <br />1B0 DAVS OF DATE PFRM17 IS ISSUED AN� iNEPEAFTER IS TO <br />BE DILIGCNTLV PURSUI57 TO COMPLETION THIS PERMIT MAV 9[ <br />C�NCCI LLU PV 7HE CITt UPON AN� STOPP�GF OF WORH ON TH:'i <br />f'Gif)J[ C i i�VCl7 ��tl (lM", f)I IR.� I If)H <br />