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PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />(425) 257-8810 <br />OWNER NAME APPLICANT NAME <br />AND ADDRESS: TaOF,.C,i4A I,7. A A T1—a'C9;nj AND ADDRESS: <br />10.1 2 Q MOtYTt A RD <br />E 5 ERETT A 93204 <br />PHONE: PHONE: <br />TAX PARCEL I.D.# PROJECTADDRESS: <br />DESCRIPTION OF SHC✓RT PLAT IMPRCYT '�uN-j" S -F `F` 02— I- C15 <br />PROPOSED WORK: — <br />PERMIT CONDITIONS <br />Date <br />2/112047 <br />Public Works Permit # PNI) 7 02— 001 <br />Building Permit # <br />Planning Reference # <br />Public Works Fee $ $ 2 , n 8 4 .2 E <br />Guarantee $ <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. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 W <br />4 • PER APPF0%TEr- f LANI S H <br />Approved for Construction Date <br />as Constructed Date <br />"';? -Q6d <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and <br />save harmless the City of Everett from any and all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because of installation and maintenance of the improvement or <br />other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public <br />roperty damageV thereby. . <br />Ze <br />✓Signature of Applicant Date <br />WORKAUTHORIZED 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 (7/06) DATABAR, INC. <br />