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Date <br />Appi�.,c8c� For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Deecribe Propoead Work <br />Prolecl Addreen lil kaown� <br />Plan Check Noi <br />App11cet.Date� <br />Job Addreees <br />owner� <br />Tenenti <br />Propoeed Uea� <br />Deec. of Work� <br />SH@D <br />B 45001 <br />07/25/94 <br />25i6 i01ST ST S6 <br />POULIN GASTON <br />SHED <br />S6PA <br />PuOhc WarM� Pbmtl • <br />e�aa D•o� • _ <br />Weii< WarY� iq <br />�ol�l Fa1 � <br />Uu AOGI i�� V�ia i <br />e.i.��. o�. t <br />Z�P Phone <br />OFFICE 3ET JOB SET z�p Phona <br />APPROVED FOR P6RMITe D11TE_/_/_ BY <br />Attach lour (4) coplas ol plana for proposed work • Drew to scale end note the lotlowing ae appliceble: <br />• Property Linea <br />• Outline and dimansione ol all a:ieling end <br />propoaed structures on the lot <br />• Exleling and propoeed utllitlee <br />• Canterline ol 6ireal <br />• Indicele North <br />• 8how any propoead gretling c�enges <br />• Show meaeuremenla <br />PERMIT C^NOITIONS <br />1. All calle for Ine�ectlon ehell bo Tede 24 hro. In edvance • phone 259•8810. <br />2. All wo�k ehell be peAormad In ecco�dence wlth thie parmit and current Clly ol Everett Deelpn end Conetructlon <br />Standarde end Specilicetione. <br />3. Cell Locallon Underground 3ervlce 4B hrs. belore you dip. TOLL FREE NUMBER 1•$00-424•$555. <br />Approved lo� COnefruction <br />UBUC WORKS PERMIT <br />NOT REOUIRED <br />�Y B <br />�ATE L� � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owneqappllcant hereby eprees to hold end eeve harm� <br />less the Gdy ol Everell I�om any end e�l claime for demagee, costa. <br />expeneee, or cauaee ol actlon Ihat mey erlae becauae ol Inelallation <br />end maintenence ol Ihe improvement or olher right�ol�wey uee hereto <br />epplied lot and fur!he� egreee to remove seme upon nolice Irom Ihe <br />Oa e City end to replece public property deme0ad thereby, <br />FINAL INSPECTION 081e <br />Approved as COnbt�uCted <br />' PUBLIC WORHS DEPARTMENT <br />�3200 Ceder Slreet <br />Everett, WA 98201 <br />Phona:259�BB10 <br />Signalure al Applicenf Dete <br />WORK AUTHOR12ED BY TMIS PERMI? MUST BE STARTED WITHIN <br />180 DAVS OF DATE PEiiMIT IS ISSUED AND THEHEAFTEF IS 70 <br />BE DILIGENTLV PUR?iUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECi OVER 90 DAVS DURATION. <br />