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PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreel <br />Everett, WA 98201 <br />(425) 257•8810 <br />OWNER NAME <br />ANDADDRESS: �-�., ,i' .- <br />., . . �, t, �,: �. <br />PHONE: <br />TA% PARCEL I.D.a <br />OESCRIP710N OF �? j 7% ST <br />PROPOSED WORK: � <br />PERMtT CONDITIONS <br />Date <br />Public Works Permit N <br />8uilding Permit N <br />Planning Relerence X <br />Public Works Fee 5 <br />Guarantee S <br />. <br />�'�Inr�.�; ., . <br />�::' <br />HYYUGNIVI IVNMt � � _,� <br />ANDADDFiESS: ' � ���V' (_ V.� � �i . <br />-� i' <br />i/ 1% `(j. J/=? jj D,�i <br />PHONE: ,�,�r �� �,�4 S(L��lf <br />j. <br />PR0.IECTADDRESS: j� , � _. ���'; ' _ <br />i ' ' <br />l�y�,�. j�- ' <br />: ,, <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 ot Everelt Design and Construction <br />Standards and Specilicalions. <br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555 <br />�� I�):. ���,'�l��i ._"!,. _ ., ��t, �� � ��:�.�� i.�. I". iJ�c iIj %�r' ��'.�i`.J <br />.<; ��'�� sT �'i� �"11��?�'� �roa.a'is��= �v fr'� :li� <- , <br />. , <br />, ,, <br />; <br />�' � f� �G /%��� �PY' ��'�/1S � �'Y' G"�;' ._ . . %l�.,�-. . <br />� .����� C,o r <br />mr. 5t" kP�� k � ��tr�P �'r'. � � , � : - , <br />ACKNOWLEDGEM[NT OF CONDITIONS <br />The undersigned owneUapplicanl here6y agrees to hold and <br />save harmless Ihe Cily of Everett Irom any and all claims for <br />� damages, costs, expenses. or causes ol aclion ihat may arise <br />because o: installation antl maintenance of the improvemenl or <br />other righl-ol-way use hereto applied lor and luriher agrees to <br />remove same upon rotice trom Ihe Cily and to replace pu6lic <br />propertytlamape¢,thereby. <br />r , ., <br />E.l-?,�,. � � .....--�^—__- <br />Sign,N�o'olApplicant Dalo <br />WORK AUTMORI2ED BV THIS PERMIT MUST BE STAR7ED WITHIN 180 DAVS OF DA7E PERMIT IS ISSUED AND THEREAFf[R IS TO BE DILIGEN7LV PURSUED <br />TO COMPLE710N. 7HIS PE(iMIT MAV DE CANCELLED DY THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJ6CT OVER 90 �AVS DURATION. <br />LPN'P 1]'OGI OAiApAR. MC <br />W <br />� <br />— <br />� <br />m <br />� <br />� <br />VI <br />O <br />a <br />