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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 <br />Public Works Permit #' <br />Building Permit # <br />Planning Reference # <br />Public Works Fee $ <br />OWNER NAME APPLICANT NAME <br />AND ADDRESS: Jim Moen AND ADDRESS: ?� <br />1008 Apache Dr. <br />Mount Vernon Na 98273 <br />PHONE: PHONE: <br />TAX PARCEL I.D.# PROJECTADDRESS: <br />4727 Sr-,ghatrs±t A-va <br />DESCRIPTION OF <br />PROPOSED WORK: Short plat` No. 1202-15-07 <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. Construct per plan. <br />s1/6/2007 <br />PU0709-002 <br />$50.00 <br />lu <br />I <br />i <br />� <br />,A <br />r.:] <br />C: <br />+:SFr `tiun� •:'si;r. <br />, i' .'] l�,I �y � �, •.`fir <br />•�-.ri <br />r-=d <br />Uri Uri <br />b <br />_ <br />a w <br />Cat--'• .P:."„ <br />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 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 />f <br />Sign of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED A D THEREAFTER IS TO BE DILIGENTLY PURSUED <br />TO COMPLETION. THIS PERMIT MAY CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />EPWP (7/06) DATABAR, INC. <br />