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Dale <br /> PUBLIC WORKS Public Works Permit# <br /> PERMITBuilding Permit p <br /> err PUBLIC WORKS DEPARTMENT Planning Reference M <br /> 3200 Cedar Street <br /> Evereh,WA 98201 Public Works Fee$ <br /> (425)257-8810 <br /> Guarantee$ <br /> OWNER NAME APPLICANT NAME <br /> AND ADDRESS: - ; -- AND ADDRESS: <br /> TO 'P01 .TING r t <br /> PHONE: PHONE' <br /> TAX PARCEL I.D.a PROJECTADDRESS. <br /> DESCRIPTION OF - <br /> PROPOSED WORK: ' <br /> PERMIT CONDITIONS <br /> 1. All calls for Inspection shall be made 24 hours in advance. <br /> 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. e ' <br /> 3. Call Location Underground Service 48 firs. before you dig. TOLL FREE NUMBER 1-800-424-5555 W <br /> r <br /> N <br /> W <br /> CA, <br /> O <br /> °° 0 <br /> �oF s <br /> SFR O <br /> nici� rT <br /> H <br /> (A <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and <br /> r y save harmless the City of Everett from any and all claims for <br /> / r Conatr Iro J?� damages.costs,expenses,or causes of action that may arras <br /> to <br /> because of Installation and maintenance of the Improvement or <br /> other rrghl-of-way use hereto ipplied for and further agrees to <br /> remove same upon notice Trym the City and to replace public <br /> FINAL INSP TION property 06maged thereby <br /> 7 <br /> Approved aConalructed Dale 1..g . _ �. ��� <br /> SI nature o pt ica Date b <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br /> TO COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br /> EPWP(heel DATAIMA,INC. <br />