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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 />Date =/2n 2f?n7 <br />Public Works Permit 0 3— 106 16 <br />Building Permit # <br />Planning Reference # <br />Public Works Fee $ ti 1, 167 . 73 <br />Guarantee $ <br />OWNER NAME APPLICANT NAME <br />ANDADDRE$§A:? 'G Tff,' ON ANDADDRESS: <br />5820-3 <br />PHONE: 1-2 F3 8 8 713 7 PHONE: <br />TAX PARCEL I.D.# PROJECTADDRESS: <br />'54 i 0 s'A RIVIE11T <br />DESCRIPTION OF <br />PROPOSED WORK3-H 7hT PLAT T1--4PR 's1E!--!E:,%7T"3 1202-12-0E, <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. <br />3. Call Location Underground Service 48 hrs. before you dig.. TOLL FREE NUMBER 1-800-424-5555 <br />4. PER PPFRKA.�n PT <br />0 <br />Im <br />O <br />Z <br />O <br />Cn <br />O <br />a <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed Date <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 />property damaged thereby. <br />Signature of Applicant Date <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 (7/06) DATABAR, INC. <br />