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oe�e--�:��/� �_ <br />AppliCetion Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Panb�. Wor�e Pe�rm1� •�— �/ `� ��^^^���� � <br />B��a ��.ni • [1 V /d� <br />�� <br />PubLc WorMr Fn <br />7oUIFn. � —.—.— <br />Le�� �ppl. Fe� Pn� s_ _ <br />Pu�nce0on � zo•nl� _ <br />B���S3 <br />Boyden Realty, Inc. 1429 Broadwny Everett 9�201 252-116F <br />Owner MellingAddress City Lp Phone� <br />J 6 � Buildere 1429 Broadway Everett <br />Applicent MeilingAddress City <br />Dnecribe Propoaed work New Sinele Pam:lv Residence _ <br />Pm�ect Address Iil kno�m) <br />98201 25:. :166 <br />ZiP Phone <br />Attech lour (41 copieS ol plans for proposed work • Draw lo scalc and note the tollowing as epplicable�. <br />• Proparty Lines • Centerline ul atreel <br />• Oulline and dimeneians ol ell eMisling nnd • Indicate Nortii <br />proposed siructures on tha lol • Show any proposed gradmy changes <br />• Existing end proposed utililies • Show mensurements <br />DU NUT WHITE BELOW 7H15 LINE <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall 6e made 24 hrs. in edvance � phone 259•B815 <br />?. All work ahell be purformed in eceordenee with thls permit and current City ol Ev.. �ett Deslqn and ConsVuclion <br />Stentlerce and Speclllcelions. <br />3. Cell Locallon Underground Service 4B hrs. before you dig, TOLL FREE NUMBER 1•B00•424-5555. <br />y .S�OfGc/dG�f' /�% %N�S lOT /S �f.�'frJ ��� !'/i1;'U'i�c?i('�il,/� <br />iW`i.aar.�c F�"" T'' %T Mc's.— d! .<r i��,1�� p h',i T11� <br />/ <br />Af /'! iCd,�✓T • <br />S AN�/ G,�aa„v�> n.✓ 7fi _r- � o.- is r- �'F i�o.�F .r�:� ��.� <br />NoT To iin��,�tcr %--� .S'�����,�n �,�'�•- ln�r cc'iTv <br />�(�'lli.t.)-(.C)dTfi� �L�/V' �1�%�- <br />App�ovedlor <br />� <br />FINALINSPECTION 1 1 �� <br />Approved as Constructed �� <br />rverelt PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Street <br />Everell. WA 98201 <br />Phane�. 259�A815 <br />� <br />Date <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />Q <br />a <br />ACKNOWLEDGEM[NT OF GONDITIONS <br />The undersigned owner/epplicant heieby egreeA lo hold and save harm� <br />less IM1e City ol Everelt Irom any end all cinims lor damages. costs. <br />ezpenses, or causes ol eclion thal mny arise becausa of installation <br />nnd mamtennnra oi �he improveman! or C�her nghl�ol-wey use heretn <br />epPlied for and furthnr eBrees to remove seme upon notice Irom thr <br />Cily pnd to replace public pwpeiry damegeA ihereby. <br />� � � ..= L / �-� ��"�,�+_� <br />Signature of Applicanl Dele <br />WOqK AUTHORIZED [1V THIS PERMIT MUST BE STARTED WITHIN <br />iB0 DAVS OF OATE F`ERMIT IS ISSUED AN� THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PER�11T MAY �E <br />CANCELLED BV THE CITV UPON ANY SiOPPAGE OF WORK ON TI�iIS <br />PROJECT OVER 90 DA18 DURATON. <br />