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� <br /> � <br /> P���1V �\0��� Date n � <br /> PERN117' Public Works Permit# . � ' � �.;, <br /> Building Permit# <br /> PU[iLIC WORKS L'EPARTMENT <br /> 3200 Cedar Streel Planning Reference# <br /> Evere9.WA 9R201 <br /> (425);57-8810 Public Work: Fee 5 <br /> Guarantee S <br /> OWNER NAIdE —""'—"'— .. . .'�p,�,i�q�lf NAME <br /> ANDADDRESS: , ,:Oi;�_'_J lci�)C_i5 . =.NJ�IDORESS: , ._f_" r,p�l'_h <br /> _:n11 Pacadise :a�- c'_:'.t � :cn.; ' <br /> _..,:;i:^P.iiSh �r-� �r,>G�-, <br /> PHONE' �. �ir_j��]7E7NE' . .` . PHONE: <br /> TAX PARCEL I.D.0 PRQIECTAD�RESS: <br /> `�tf1Ef �. l�n+,+oc,d - ,-na� <br /> DESCRIPiI`ONOP ;� :, . 11 :. r.::7 ' �.L' <br /> PROPO WORK: � 7 L=__ . _ 1_ � C3P�!e �!9C C1117'11.3[' 4'1!:•?L?-3� '•t �-3f_ <br /> . ..[:.:-':"' 1. 1�,p: <br /> PERMIT CONDITIONS <br /> t. All calis for inspection shall be made 24 hours in advance. <br /> 2. All work shall be perlormed in accordance with lhis permit and current City of Everett Design and Construction <br /> Standards and Specificatiuns. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555 W <br /> :��_ . _ __ �, . � <br /> '�A <br /> . Appl�+ traffic icr.rr•�: 1 ?<,:; .,_ _ _,�:=.�'e•J c: plsn v+ <br /> kemove and rep?ace sidewalk fecm �oint tn jolnt �� W <br /> �-a1ly 5�� , and use beddinq and cateria: per "'�� O <br /> Cit�• of r,:c•r«�t.t �r: � <br /> r �`.-. Ficat,ion� ^ <br /> _ <br /> � <br /> . - _ Z <br /> O <br /> '�^ <br /> - V+ <br /> O <br /> a <br /> �:; � /; . ACKNOWLEDGEMENTOFCOND�TIONS <br /> ��� The undersigned owncr/applicant hereby agrees to holtl and <br /> � y�t��L�,��' � 7 ����-� save harmless the Crty of Everett Irom any and all claims br <br /> �� Appro ' r on�tmaion po� damages,costs,expenses,or causes ol action that may arise <br /> � ' ' becauas of inslallation antl mainlenance ol Ihe impmvement or <br /> L� o l h e r i ig h 4 o F�v ay u s e he r e to applied lor and luriher agrees to <br /> 4— - / - Z G7 remove same upon notita irom lhe City and lo replace public <br /> INAL INSPEC N � property damagetl Ihereby. <br /> Appmvetl as nstructed Date - <br /> . . -� �` ' .__�._ . _ . .-. _ . . . . <br /> SignaluroolApplicanl Date <br /> INORKAUTHORIZED OY THIS PERMIT MUST BE STARTED WI7HIN 1B0 DAYS OF DA?E PERMIT IS ISSUEO AND THEREAFfE(i IS TO BE DILIGENTLY pURSUED <br /> TO COIdPLET10N.THIS PERMIT MAV�E CANCELLED�Y THE CITV UPON ANY S70PPAGE OF WORK ON THIS PRQIECT OVEF 900AVS DURATION. <br /> f:Pvrr i�nel , <br /> DATAOAR.ING. <br />