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Date 3 6 86 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Watt Perm" • 69(6,— 9s <br />awb enrol . 86/16151 <br />Pubik Wort" I N <br />rolxl Fe, >' — <br />LIU AM[ F0. Pud a q <br />a..�tnce 0u0 <br />Boyden Realty, Inc. 1429 Broadway Everett 98201 252-1166 <br />Owner Malting Audress City Zip Phone <br />J & D Builders 1429 proadway Everett 98201 252-1166 <br />Applicant Madinq r ,dress City Zip Phone <br />Describe Proposed Work New Single Family Residence <br />W <br />Project Address (if known) 128 — 93rd St.. S.E., Everett <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />/^ <br />• Outline and dimensions of all existing and • Indicate North <br />V <br />proposed structures on the lot • Show any proposed grade w(it, <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />O <br />1. All calls for Inspection shall be made 24 his. in advance • phone 259.881 5. <br />aaa>+ <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />4. ANY GRADING DONE ON THIS LOT SHALL BE DONE SO AS NOT TO IMPACT THE <br />SURROUNDING LOTS WITH RAINWATER RUNOFF. <br />5. DOWNSPOUTS "ROM THE BUILDING ARE TO BE TIGHT -LINED TO THE PUBLIC <br />O <br />DRAINAGE SYSTE.. <br />6. ANY CURB & GUTTER DAMAGED DURING CONSTRUCTION SHALL BE REPLACED BY THE <br />APPLICANT. <br />N <br />O <br />a <br />Approved as <br />PvrrPil <br />e <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right•ol•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />C . 4R170` a <br />Signature of Applicant D e <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STA TF.D WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />