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i <br />Dale ' � <br />Apphcation For <br />PUBLIC WORKS PERMIT <br />Print or Typ + Only <br />�.�n.�.wo,.�n�,...�i. .y�.5-7(' b� <br />emo oao� . �5 r� �-��-- <br />f -- <br />vuol¢ Wa�4f Fee. <br />Taiei �ee 5 _ <br />leu �001 Fee Va�J S <br />�_— <br />Ba�e�ce Due 6 � <br />�/ysy <br />Boyde+n Realty, Inc. 1429 Aroadway Gverett 98201 252-1166 <br />Owner Mailuig Adtlress Ciry Z1p Phone <br />J S D. Buildera 1429 Brue�wnv Eveigst 98201 252-1166 _ <br />qppP,cnnt Mniling AaAress City Zin Phone <br />Dasrribe Proposed Work NPv Sin�ip Fnmi 1� Roni.inr,rr __ <br />Prolect Add�ose UI Nnown� <br />Attech lom �41 coplas ol plens lor C'�Posed work - Draw lo scnle end note the lollowing as applicahi� <br />• P�operty Lines <br />• Outline end dlmanelons ol ell eaisting nnd <br />proposed slructures on the Icl <br />• Exisling and p�oposed utllilies <br />• C�nterline ol sireet <br />• Intlica�e Norih <br />• Shuw eny proPosed 9raAin9 chanr.,`s <br />• Show �nenswcments <br />PERMIT CONDIiIONS <br />t. All calls lor inspection shall be made 24 hrs m aAvnnce - nhune 259•8815 <br />2. All work 6hnll be porlorreed in eccortlanet wi�h this permil nnd cunent Ctly ol Eve�rell Desiqn and ::onsPur.bnr <br />Stande�d9 end Specilicelbns. <br />3. Cell Locelion Underground Service 4B hrs. bafore you dir TULL FREE NUMBER 1•B00•424•5555. <br />!. :4=�del•f� /1� T.v.s ,� n�- /� .[/f: : � � l�it,'G�'cf� �rJ <br />� j� l�i0/»�iGf� %O /." I✓I(S"T !E �'Fi'[dCFL� G'd <br />T�F Af��'� �� a ti'T. <br />� �in.� l.e�fD�n:%- oN 7i�E !_ oT /S ?z �� F /�� ��c <br />`;.'i LJ ,� �IIOT TO IM/�AC 1' is/F .S� <','. �r v:�:.� 'j: CCTS <br />� � <br />(< �%%.f� .('�1 '.t' !t =fP?' 2 �C ( .t' � �(r , <br />;.lf�-�•,.�� /.s.�'/ <br />Apprnv?d lo' C�on D� <br />C�ll� - z,( �l d2— <br />FINA� IN3PECTION Date <br />ApproveA es Constructed <br />vveretl PUDLIC WORKS DEPARTMFNI <br />� 3200 Cednr Slreel <br />[veretl. W� 98201 <br />Phrn�o 259�8815 <br />A.'hNOWLLDGEM1IENT O� CONDIiIONS <br />W <br />H <br />���w <br />_ / <br />� <br />O <br />� <br />� <br />O <br />a <br />lh�� und�rsqned ownerinpphcanl h�roby egroes lo hnld �nd save haim� <br />h�s�. Il�c Cny ol Everetl Irom Tny and el! clalms lo� dnma9Ps, osts, <br />expen,rs, m cauxes ol Pction Iha� mqy anse ber,ausr ol uislallaUon <br />and mamlenance ol Ihe miprov<rtent m othe� ri9hi-cf-way use hereto <br />epplied lor nnd lurlher egrees lo remove 5eme upon noUce hnm IM1e <br />Clly anA to rep�ace pubGc properly dameged the. r.try <br />��/""^��r..� l�� _ L.ov� �� sy i._ <br />Siqne�vre o' ApPliCnn� . C)�te <br />1NORK AUTHORIZED 21 THIS PER,NIT MUST BE STARTED WITHIN <br />tdU DPVS O� DATE PERMIT IS IS:IUED ANU TNEREA�TER IS TO <br />3; DILIGENTLV PURSUE� TO COMF�LElION. TNIS PFf7M1T MAV BE <br />CANCELL EU BY TNE CITV UPON ANV STGPPAGI- �l� WORK ON THIS <br />P40.ICr,7 OVFR 90 LlA1'S I)Uf7AtIJN <br />