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Date <br />Application For a ' <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicanf <br />DsecHbe Proposed Work <br />Pro�ect Addraes pf known) <br />� <br />Pu01k Workt MrmN • <br />BIEp D�OL � _ <br />PuWk WorlU FN <br />Tobl Fu f <br />L�N AppL Fq P�IE s <br />B�I�nu Ou� i <br />Plan Check No: H 44310 SEPA <br />Appllcat.Dates 05/05/94 <br />Job Addreees 61Y0 LrLEMING ST <br />Owner: SHIPLBY BRIAN L <br />Tenant: <br />Propoeed Ue�: GARAGE 2ID Phone <br />Deec, of Works • <br />POLE BUILDING (SASIC 260) <br />OFFICL+ SET JOB S8T Z�P Phone <br />APkROVED FOR PERMIT: DATB_/_/_ HY <br />Attach four (4) copfea of plana for propoeed work • Draw to acale and note the following as appliceble: <br />� Property Llnee • Cenlerline of atreet <br />• Outline and dimensiona ot all exiaNnp and • Indicate North <br />piopoaed etructures on the lot • Show any propoaed yrading changea <br />• Exlsting and proposed utllitiea • Show meaeurements <br />PERMIT CONDITION3 <br />1. All calla for Inapsction shali be made 24 hra in advance • phone 259-8810. <br />2. All work ahall be psrformed In accordance with thla parmit and current City of Everett Deeign and Conetruction <br />Standuda and Spaclficatione. <br />3. Call Locatbn Underpround Service 48 hra. befue you dlp. TOLL FpEE NUMBER 1•800-424•5555. <br />ADPiovedfo� Conatructlon Date <br />F�NAL INSPECTION Date <br />Approved aa Constructed <br />',.� � PUBUC WORKS DEPARTMENT <br />� 3200 Cetler Street <br />Everett WA 98201 <br />Phone: 259•8810 <br />PUBLIC WORK8 PER�IIT <br />NO EOU�RED <br />BY <br />DATE S / L <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett lrom any and all claims for damepea coat& <br />expenses, or causes of action that mey arise because of installetion <br />and mainte�ence o( the improvement or other right•ol-way use hereto <br />applied for and turther agrees lo remove same upon notfce Irom the <br />City and to replace public property damayed thereby. <br />Signature ol Appllcant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THC'riEAFTER 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 />