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�� PUBLIC WORKS �nte <br /> Public Works Pormil X <br /> PERMIT Bullding Perm11/I <br /> PUOLIC WORKS DEPARTMEN7 Planning Releronce N <br /> 3200 Cetlar Streot <br /> retl,WA 9fl201 p�ai�yyprks Fee S <br /> E�4P�,;2��,iTl NG.r,+r,�...J..l..zon� <br /> , , Guarentee S <br /> ----- - -___— <br /> __----- -- ----- _____..------- <br /> .-.-_... ..-. - . .. .. - APPUCANT N4ME <br /> UWNER NAME ANDADDRESS� <br /> ANUADDRES6� � <br /> PNONE: PHONE: <br /> ___.__ _"_._ '—__"—_'—.____--_ <br /> ____—— <br /> TA%PARCELI.D.I � PRQIECTADDFE55 <br /> ____ ..._ __ . __ . <br /> ._ ._ �__.—_—_ — _"'_�____._�"_____—___—__' <br /> DESCHIP710N OF <br /> PROPOSED WORN: � - <br /> PERh11T CONDIIION:i <br /> 1. All calls lor inspechon shall be made 24 homs in edvance. <br /> 2. All work shall be per!ormed in acwrdance with ihis porm�l and cwrent Ciry of Everelt Design nnd Cons�ruc�ion <br /> Stendards end.`ipecilicetions. �� 1 <br /> 3 Call Loca�ion Underc�round Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800d24-5555 Yi <br /> r <br /> � <br /> N <br /> m <br /> O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> � � � � - - � ���- �� - ------- -� � ACKNOWLEDGEMENT OF CONDITIONS <br /> � - The underslgned owner/epPGcant hereby egrees to holtl and <br /> save hartnless the Ci of Everett Irom any and all claims for <br /> ' �������,[���4- damngos,costs,exp nses,or ceuses ot aclion ihel may erise � <br /> � �ppprov e or C�r ion De�e bocnuse ol inslnllation nnd maintenence ol ihe improvemonl or I <br /> i � ' '� % othei nght-obway use horelo epphetl lor and lurther agrees to i <br /> I ,,.-� ��� � _ � remov ame upon notico Irom the Ciry end to replace public i <br /> I r� fs.<_--_.....r_.�_ -_cs______:. pro tl e dlher'g�p}y�y/ <br /> Flyqk SPECTION `J��<--I ����� <br /> iA{qrove0 es Conslruc�e0 Uxte � <br /> . ' II ', .' �' ° � S�g n ure I IKanl Dnle <br /> 7�0 f.OMPLET�19N TMSyPf-R��T�dAY OG CANCE 1 E�0��HE(MI V�UPON AN�SIOPPAGF.OF WOqN ON TNIS PROJECT OVGR 90 DAVSIDURATTONPUPSUED <br /> DAUB�R.ING <br /> 1 vv.P i!n!n <br />