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<br />PUBLIC WORKS
<br />PERMIT
<br />PUBLIC WORKS DEPARTMENT
<br />3200 Cedar Slreet
<br />Everett, WA 98207
<br />(425) 257-8810
<br />OWNERNAME
<br />ANDADORESS ���' C' `�'' ��i I, C':��
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<br />PHONE: . c_ ., ."�' le l�Ja.. 7
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<br />TAR PARCEL I.D.a , d r- �_ ... .
<br />DESCRIPTIONOF 4 ����.. /R.//, _ O�
<br />PROPOSED WORK: W Ir
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<br />PERMIT CONDITIONS
<br />APPLICANT NAME
<br />AND ADDREaS:
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<br />PHONE:f� ;_ i.
<br />PRQIBCTADDRESS:
<br />Date
<br />Public Works Permit x
<br />Building Permit #
<br />Planning Relerence A
<br />Public WorkS Fce 5
<br />Guaranlee S
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<br />1. All calls lor inspeclion shall be made 24 hours in advance.
<br />2. All work shall be perlormed in accordance wilh ihis permit and current City ol Everell Design and Conshuclion
<br />Standards and Specilications.
<br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLI FREE NU��IBER 1-800•424-5555
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<br />Approved as
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<br />ACKt�OWLEDGEMENT OF CONDiTIONS
<br />Tha undersigned o�medapplicant hereby a9rees to hold antl
<br />, savo harmless tho Cily of Everett Imm any and all Uaims lor
<br />�✓ �� damages, wsls, ezpenses, or causos ol adion thal may arise
<br />becauso ot installalion and maimenanco ol the impmvemeN or
<br />olher right-ol-way use hereto applied lor and lutlher agrees to
<br />remove same upon nolice Irom the City antl to mplace public
<br />property damaged thereby,
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<br />Signatura pl Applicanl Oatc
<br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 �AYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO BE OILIGENTLV PURSUfD
<br />70 COMPLETION. THIS PE(iMli MAY BE CANCCLLED DY THE CITV UPON 4NV S70PPAGE OF \YORK ON THIS PROJECT OVER 90 DAVS DURATION.
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