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Date1� <br />Applicetion Fo� <br />PIJBLIC WORKS PERMIT <br />Print or Type Oniy <br />Boyden Realty, Inc. 1429 Broadway Everett <br />Ownar Meiling Atldress �i�y <br />J 6 D Buildere 1429 Broadway Everett <br />AUPlicact Melling Add�ess ���y <br />Deecribe ProVosatl Wo�k __New Single F&mily Reeidence <br />PuOb; WorwePnrmil• v�-p� �/T' <br />BiEp Oepl � ��] 7�� <br />Fu4hC Worh� Fee <br />Tol�� Fee s _ <br />les�Appl LeePUE S <br />B�InnceDue f �QOO <br />98201 <br />Zip <br />98201 <br />Zip <br />�'3S <br />252-1166 <br />Phone <br />252-1166 <br />Prolect Address (ll knowrp ��� — J.� ���. ,S'L� C O T�`,�__ <br />i <br />Atfach �our (4) copies �f ?lana for proposed wurk - Oraw lo scale xnd note the lollowinp as npolicohle� ���� <br />• Property Llnes <br />• Outlina end dimenalons ol all exieting and <br />proposod sl�uctures on ihe lol <br />• Eaia�ing nnd proposed ulililies <br />PFRMIT CGNDITIONS <br />• Cenle�line o� slreet <br />• Indicale North <br />• Show any proposed graAinp changes <br />• Show measurements <br />� Ni cans lor ir speclion ahall be made :4 hrs. in advence phone 2SQ•B8i 5. <br />2 All work shall be parformcd in accomanr.e wilh fhis permit ona current City ol Everelt Design and Conslructlon <br />9funderds end Specilicellens. <br />3. Gall Locetlon Unda�ground Service 4B hrs. be�ore you dig 70V. FREE NUMBER i•800•424•5;i55. <br />4. Stdewalk at [hiy lo[ la new end unbroken. Any damage [o i[ will require <br />replacement by the applicant. <br />5. Any grading on [he lot fe [o be d„ne eo as not to impac[ the surrounding <br />lots witfi rain-water run-off. <br />6. Down spou[s frort, [he houac are to be [iKh[-lined [o [he drainnge syetem. <br />/ �'cA �,t/•�dG�flY //� a'G <br />Approved lor Construrlion Date <br />� �: z ����� <br />FINAL INSPECtION p�— <br />Approved e s ConslructeU <br />evrrr�� PUBLIC WORKS DEPARTMENT <br />� 3200 Codar Slraet <br />Everetl, WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT O� CGNDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/npphcan:herebyegree5lo holtl and �..�"� h.nni- <br />less Ihe Cdy ol Evaret� Irom any Nnd all claims lor tlamayes. i:osis. <br />eMpenses, or ca�ise5 0l nclion ihat mny erisa becau9e o� mslallation <br />anA mxm�enance ol Ihe improvemen� or olher iight�obway use hnreto <br />applietl lor nnd further egraes lo remove same upon nollce from the <br />Cily nnd to �en nce pubGc property damaged thmeby. <br />.: � � ' �� o� � <br />c w._ n <br />Signalure o� AnP�icanl ale <br />WORK AUTH0+71ZED BV THIS PENMIT MUST BE STARTED WITHIN <br />780 DAVS OF DATE PFRMIT IS ISSUED AND THEREAFiI:q IS TO <br />BE DILIGENTLV PUR£UED TO COMPLETiON. THIS PGRMIT MAV BE <br />CANCELLED BV TNE GTY UPON ANV STOPPAGE OF WOFH ON THI i <br />PROJECT OVER 90 DAVS DURATION. <br />