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PUBLIC 11VORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Stroot <br />Evcratl, WA 98201 � <br />(4251257•BB�q� � <br />Dale l�-30-9 9 <br />Public Woiks Permit M <br />Building Pormit a <br />Planning Relerenco M <br />Public Works Fae S �� <br />S <br />uvvncn rvnmc AND ADDflE55: <br />ANDAOORE55: <br />�y LJ�W�C� dJ E✓i.�,//) �fiG Cv�r2R�T1 <br />7;0 /3EJrQGY i3� � Po �3�* �3533 wric.� c✓l�ti� •`''�� <br />� PMONE: 3Gv N3 S 0 i� � <br />PHONE: y}s 3SS� 73 9 <br />TAX PARCEL I.D. � <br />DESCRIPTION OF <br />PRUPOSEDWORK: EMI��� <br />SI"cPS !J <br />PERh11T CONDITIONS <br />I PROJEC7 ADDRESS: ��Q�I D eV �� I <br />IJ <br />O/��r �F Q�cK" �� R,�� /1J <br />�PPtR y/a�� �— BCvc.� sio�waL,C <br />1. All calls lor inspeclion shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be perlormed in accordance wilh ihis permil end currenl City ol Everett Dasign and Construction <br />Standards and Specificatiuns. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555 <br />� 7�n;L`,(,� S/c�fG✓4� CLOS¢� �1¢Oc: S/9N5 On C�iC�i. <br />• ,Tn�¢rSeo�ien It/o�-Fii � Soclfti o� �I^�f'_ <br />�J, <br />� <br />�roy�d6 Qh�r Qd�/'�/OOA� fi^a[T�G �Oh�rod QS <br />�rec/� 6r �tie /��6Cio u�ohE.r /ns�zcfor a- �e <br />T/'a T7 � � O'C�14 r'�M c n f <br />A��/ �!I<•t4Jc %�Ub� I G /tM�YOI/a��t a/� %'S CG ur6�,9U� r <br />.Sia/�: c,�aL�-, �f�� h� �sf 6� r�pta�ed/,Pe�ai� Qs d�ec f�� <br />ACKNOWLEDGEMENT O(� CONDITIONS <br />The undersigned owner/applicant ho:eby agreos to hold end <br />savo harmless tlie Ciry oi Evoretl Irom any and all clalms lor <br />damages, costs, oxpanses. or causos of aclion that may arise <br />becauso ol installation and maintonance o11ho Improvamentq �I <br />other right-of use horolo aoplied for end furthor agrees td� <br />removo same u n netice irom Ne City and to replaca public <br />propo �da horeby <br />�., �� /� .�0 9 <br />SignaWre ol Applkanl Dat <br />TJO COMPLETOION TH S PERM T MAY 6E CANCELLEO BY�THE CITY�UPON ANVOISTOPPAGE OF WOPK ON TMIS R0.1 C OVER 90 D VS IDUR T ONPURSUED <br />