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- � P�Elic Worka Pemn• <br /> Date <br /> . 61ap.Deo�.• <br /> Applicalion For <br /> PUBLIC WORKS PERMIT P�EIicWorkaFee <br /> Totel Fee s <br /> Less Appl Fea PaiO S <br /> B�lance Oue s <br /> Print or Type Only SEPA <br /> Plzn Check No: B 46132 • <br /> Applicat.Date: 11/04/94 <br /> Sob Addr�: 109b4 1ST SE SE <br /> Owner: BALLARD BILL <br /> Tenant: :ip phone <br /> Owner Proposed Use: GARAGE <br /> Desc. of Work: <br /> NEW GARAGE <br /> ;ip Phone <br /> qpplicant OF'FICE SET JOB SET <br /> APPRVD FOR PERMIT: DATE_/_/_ BY <br /> Describe Proposed Work _ <br /> W <br /> Project Address(if known) � <br /> �� <br /> Attach four(4)copies ol plans for pioposed work• Oraw to sc�le and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street <br /> • Oulline and dimensions ol all existing and • Indicale Norih <br /> proposed structures on the lol • Show any proDosed gratlin47�hanges <br /> • Ezisting and proposed utilities • Show measurements M <br /> W <br /> UO NOTN'RITE 9ELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shell be mada 24 hrs.in advance•phone 259•E310. <br /> 2.All work shall be pertormed in eccordance with ihis permit and r.urrent Ci�y of Everett Design and Constructlon <br /> Standerds and Specifications. � <br /> 3.Cail Lor.alion Underground Service 4B hrs.hefore you i:ig.T(�L'.FREE NUMBER 1-t3']0•424•5555. <br /> O <br /> ?UBLIC WORKS PERMIT � <br /> fdOT OUIREII � <br /> �Y ` 3 O <br /> iIATE � y � � <br /> a <br /> ACKNOWLEDGEMENT OF CONCITIONS <br /> The undersigned owner/appl�cnn'hereby a9rees to hold and save harm� <br /> less the City of Eve�etl Irom a.iy and all claims for Camages, costs, <br /> ezpenses, or causes of action that may arise because of installation <br /> and maintenance ol the improvzment or other right•ol•way use hereto <br /> applied tor and further agrees to remove eame upon notice trom the <br /> Approved tor Construction Dale City and to replace public property damaged thereby. <br /> FINAL INSPECTION �a1e — Date <br /> Approved as Constructed �i;;^aWre ol Applicant <br /> �y�, YJORK dUTHORI2FD BY THIS PERMIT MUST BE STARTFD WITHIN <br /> �A1� PUBLICWORKSDEPARTMENT 180 Ol.YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON�HIS <br /> Phone:259-8810 pROJ�CT OVER 90 DAYS �URATION. <br />