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<br />PUBLIC WORkffi�I��P�RT�i�t1:F,.J1j�T;=�
<br />3200 Ce`cl�f'Str�`�t` -'" ``` -
<br />Everett, WA 98201,
<br />(425) 257 88��:i;;. ;i;,s f'��,' �:
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<br />OWNERNAME
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<br />PHONE: �`�-,2�,_!.; +,
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<br />DESCRIPTION OF
<br />PROPOSED WORKT;TF°:'.•* �;.�'s.�`�.''.a:r i:T,,i:=%�_ti�'c_t �_�:. ��= � v ��I
<br />PERMIT CONDITIONS
<br />Date '� i-, �
<br />Public Works Permit�'���`�:�r,�t}-�1 ;i •? � �
<br />Building Permit # �=" :� �_ < i i - �� t;?
<br />Planning Reference #
<br />Public Works Fee $
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<br />Guarantee $
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<br />1. All calls for inspection shall be made 24 hours in advance.
<br />2. AlFwork shall be performed in accordance with this permit and current City of Everett Design and Construction
<br />Standards and Specifications.
<br />3. Call Location Undecground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555
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<br />proved for Construction Date
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<br />L INSPECTION
<br />Approved as Constructed Date
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<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 ther
<br />:
<br />Sign �ure 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)
<br />DATABAR, INC.
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