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PUBLIC WORKS PERMIT <br />City of Everett Public Works Department <br />3200 Cedar Street <br />;N y,• Everett, WA 98201 <br />(425) 257-8810 <br />Date: <br />11 /2/2010 <br />Public Works Permit #: <br />PW1011-001 <br />Building Permit #; <br />Planning Reference M <br />Public Fee $: <br />$ 45.00 <br />Works <br />fP-01 /' Other $: <br />41 -76-D. o <br />OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br />JOHN GAMLAM JESSE JARRELL <br />21818 66th AVENUE WEST#2 WESTERN ENGINEERS <br />'MOUNTLAKE WA 98043 EVERETT WA 98204 <br />PHONECE <br />: 4257781390 PHONE: 4253562700 <br />TAX PARCEL ID # I SITE ADDRESS: 5613 BROADWAY AVE. I <br />DESCRIPTION OF PROPOSED WORK: <br />SHORT PLAT 1202-10-006 <br />(11/2/2010 1:31 PM BES) <br />A MINIMUM OF 1" WATER FOR LOT 2 IS REQUIRED. <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 the permit and current City of Everett Design and Construction Standards <br />and Specifications. <br />3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 811 <br />4. CONSTRUCT PER APPROVED PLAN. <br />m <br />CW <br />r , <br />r <br />T <br />myn' <br />r.-3 -n M <br />�--lCo G= <br />u <br />C <br />T� <br />F1 <br />'` <br />by <br />`wO <br />` J <br />r•. <br />r' <br />:O <br />Fn0coono <br />`��,c'c' <br />O <br />c-7r�r <br />4N- <br />r•,:, <br />a <br />I I <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 <br />or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace <br />public roperty damaged thereby. <br />(�2 —1� ' - <br />Signaturelof 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 <br />PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />r' <br />