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OWNERNAME <br />AND ADDRESS: <br />PHONE: <br />TAX PARCEL I.D.# <br />PUBLIC WORKS <br />Date <br />Public Works Permit # <br />PERMIT <br />Building Permit # <br />PUBLIC WORKS DEPARTMENT <br />Planning Reference # <br />3200 Cedar Street <br />Everett, WA 98201 <br />(425) 257-8810 <br />Public Works Fee $ <br />Guarantee $ <br />C iz C3 `fit -'' E 1RCT inv. <br />4i'i 539 F 901iF <br />APPLICANT NAME <br />AND ADDRESS: <br />95205 <br />PHONE: <br />PROJECTADDRESS <br />PROPOSED WORK: 5HCf kT- P .r o3 <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 />rr3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />F..... I....1 <br />W <br />5 <br />Cn <br />4 <br />�F <br />!'<d <br />r� � <br />J1:1 <br />z <br />OC,u' <br />�•Cl) <br />Ca e'w <br />O <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 />Approved for Construction Date <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 />INSPECTION <br />Approved as Constructed Date <br />property damaged thereby. <br />E / <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 (7106) <br />DATABAR, INC. <br />