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Date z�z6/93 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Bill Walkaz 2601 Walnut Everett 98201 778-8465 <br />mer Mailing Address City <br />P�er,� wo.x, ae�mn . <br />B�aa oeo�. • 39693 <br />Pu01¢ Woib Fea <br />iolel iee s - <br />Less Aopl Fee V�iE s <br />Belance Dee .i <br />Phone <br />Dennis Markey (Permabilt) 74_-1.555 <br />Applicant Mailing Addrass City Zip Phone <br />Describe Proposed Woik Pole building — garage <br />Project Address lif known) <br />Attech lour (4) copies of plans for proposed work • Draw to scale and note Ihe tollowing as applicable: <br />• Property Lines • Centerline of sireet <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Ezistin9 and proposed utilities • Show measurements <br />PERMITCONDITIONS <br />t. All calls 1or inspaction shall be made 24 hrs. in edvance • phone 259•8870. <br />2. All work nhall be performed in accordance with this permit end current City of Everett Design and Consiruction <br />Standardu and Snecifications. <br />3. Call Location Und?rground Service 48 hrs. before you dip. TOLL FREE NUMBER 1-800�424•5555. <br />for Construction <br />PUBLIC WORKS PERMI7 <br />N07 REOUIpED <br />BY � <br />DATE 3 /D P3 <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�PUBL�C WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT 0:= CONDITIONS <br />W <br />H <br />� <br />The undersigned u�vner/app�icant hereby agrees tc hold and save harm• <br />less Ihe City of Eee�ett Irom any and a�l claims br damages, costs. <br />ezpenses, or causes of action that may nrise because of installetion <br />and maintenance ol the improaement or cther right•oFway use hereto <br />applied lor and �urther egrees to remov+ ;ame upon notice irom ihe <br />City and to replace public property dam27ed therAby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERIdIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TC� <br />BE D�LIGENTLY PURSUED TO COMPLETION. THIS PE7MIT MAY " <br />CANCELLED BV THE CITV UPON ANY STOPPAGE OF N�ORK ON TF <br />PROJEGT OVER 90 DAYS DURATION. <br />