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Dete��_ <br />Appllcation For <br />PUBLIir WORKS PERMIT <br />Print or Type Unly <br />Realty, Inc. <br />Owner <br />1429 Iiroadway <br />Meilmg Address <br />Vu�l�� 0.o�w� PvmH • ��_ �� <br />BiCp Dn�l ��.���9/z <br />PuO�K Woq�: a� -- <br />7ob�fa� � <br />LR:� �pC� ��! P�iE � <br />a.i.�e. o�. t _ <br />7poo <br />-- � ; 9 - <br />Evere[t 98201 252-1166 <br />C�ry Zip Phone <br />J 6 D Buil.dera 1429 Br�adway Everett 98201 252-1166 <br />AppliCent Mailing Atl:lrese Gity Lip Phone <br />Jeawfba '�oposed �4ork _ New S <br />Residence <br />--- - t,� - .- �` - <br />Pro�act Addresa �II known) �� �� _. �� — �• �, �� lOT � <br />fs9� C•.. c <br />Attach lour �4) coples ol p'ans for a�o� � ���, w� •k - Jrew to acale and note the lollowing as apPhr.ehle� <br />• p�operty Unee <br />p Outline nnd dimensions n' ell exlsting entl <br />pioposed str�ctures on tGe lot <br />• EMisting end p�opoaed uti'd�es <br />PERIAIT CONDIT�ONS <br />• Cenlerllne of sl�eet <br />• Ind�cete North <br />• Show any proposed grading cbanges <br />• Shqw measuremPnls <br />1. All cells lor inspeCllon �hell lie mede 24 hB. in edvence � phone ZS�•EBi S <br />2. FII work shell ba perbrmed v� ecwrdance with this permit and wrrenl City ol Evarett Design and Conshuction <br />Stcndards end Spacllicetlons. <br />3. Call Locetion Underground Service 4B hrs. before you di� TOLL FREE NUMGER 1•800•424•555.ri. <br />Sidewalk at [hie lot is new and unbpOken. Any damage [o it will require <br />replecemenc by [he applicant. <br />5. Any grading on the lo[ is to be done so a.: not tn impac[ [he surrounding <br />lote with rain-water run-off. <br />6. Down apouta from [he house are to be [ight•lined to the drninage sys[em. <br />��=a-l�'� i "�r%'iQ.�� <br />Approvedlor nstr tion Date <br />S_�__ <br />FINAL :NSPE TION Dalu <br />Apptovad es CnnstructeA <br />evrretl NUBIIf. WqRKS DEPARTMENT <br />� 3200 Cadar St�eet <br />Eveiait. WA 98201 <br />, Pho�e�259�861� <br />ACKNOWLEDGEMENT O` CONDI'ION.S <br />W <br />� <br />� <br />�1 <br />� <br />The untlersig�ed oNner/applicanl hereby apreeF ;o hold and sxve herm� <br />lesn Ihe Cily of Everett Irom any en? all rtaims tor damegas. costs. <br />exPenses, or causes of action ihat mey arise because cl installation <br />und mTh�tenence ol ihe Improveman' m other npht�ol�way use hareto <br />eFV��ed for and furiher agrees to remOve seme upon no�ite hom Ihe <br />Gty anA to replace pubhc propurtv tlamag�ad theraby. <br />..� `�, �-C". ���• `Y j`� <br />Slgnelure OI Appficant � .Ue�e <br />WORK AUTHOf'�ZLD BY THIS PERMIT MU�T BE STARTED WITHIN <br />1B0 DAVS OF UATE PERM�T IS ISSUED AND THEREAFTER �S TO <br />BE DILIG[N7L7 PURSUED TO COMPIFTION THIS �EfiM1T �dAY BF <br />CANCFLLED FY THC CITP UPGh ANV Sl OPPAGE OI WCRK nN TNIS <br />PROJLCT OV'_R 9(1 DAY i fiUfIATI�IN <br />