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Dat6_ 3/6/86 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />gibbvc Works Permit e 6—/4,L <br />Bldg Daft a 86/16TGT <br />Pubit Works Fee <br />Total Feu Q <br />Len APPI. rise Paid f <br />Balance Due If 2 <br />Boyden Realty, Inc. <br />1429 Broadway <br />Everett 98201 <br />252-1166 <br />Owner <br />Mailing Address <br />City Zip <br />Phone <br />J s D Builders <br />1429 Broadway <br />Everett 98201 <br />252-1166 <br />Applicant <br />Meiling Address <br />City Zip <br />Phone <br />Describe Proposed Work New sin Is family residence <br />4 5 7__ - UJ <br />Project Address (if known) 212 — 93rd St SE <br />Attach tour (4) copies of plans for proposed work - Draw to scale and note the following as app'icable. t•� <br />• Properly Lines • Centerline of street / w <br />• Outline and dimensions of all existing and • Indicate North V, <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilitios • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS o <br />1. All calls for Inspection shall be made 24 his in advance - phone 259.8815. <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 1.800.424.6555. <br />4e ANY C'ADING DONE ON THIS LOT SHALL BE DONE SO AS NOT TO IMPACT THE <br />SURROUNliNG LOTS WITH RAINWATER RUNOFF. <br />5. DOWNSPOUTS FROM THE BUILDING ARE TO BE TIGHT —LINED TO THE PUBLIC <br />DRAINAGE SYSTEM. <br />6. ANY C7RB 3 GUTTER DAMAGED DURING CONSTRUCTION SHALL BE REPLACED BY THE <br />APPLICANT. '^ <br />CI / <br />O <br />a <br />Date <br />Approved as Constructed V V <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 982018201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownertapplicant hereby agrees to hold and save harm- <br />less the Clty 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-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to re/ptt/ace public property damaged thereby. <br />Signature of Applicant Dfie <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED 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 g0 nAYS DURATION. <br />