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-���:�, �� <br />PUBL� WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />(425) 257 8810 <br />OWNERNAME <br />AND ADDRESS: <br />� <br />PHONE: <br />TAX PARCEL I.D. # <br />DESCRIPTION OF <br />PFiOPOSED WORK: <br />PERMIT CONDITIONS <br />APPLICANT NAME <br />AND ADDRESS: <br />PHONE: <br />PROJECT ADDRESS: <br />�ate <br />Public Works Permit # <br />Building Permit # <br />Planning Reference # <br />Public Works Fee $ <br />Guarantee $ <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <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 />� v�a �� �D ��'-�-d v; � � � � � <br />� � `� , <br />� ' � ( 200 � . `— �- - --� _� <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed Date <br />_� S��vtf� S- Z�I-p� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />�; The undersigned owner/applicant hereby agrees to hold and <br />I 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 <br />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 />