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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 />Dale <br />Public Works Permit N <br />Building Permit N <br />Planning Reference N <br />PaNic Works Fee $ <br />Guarantee $ <br />OWNER NAME <br />APPLICANT NAME <br />ANDADDRESS: - , -,i.. - <br />ANDADDRESS: <br />PHONE: - <br />PHONE: <br />TAX PARCEL IA.# <br />PROJECTADDRESS: <br />DESCRIPTION OF <br />PROPOSED WORK:':z. .. - <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 1-500-424-5555 <br />W <br />'•.n:1e:. <br />110-11 <br />. 1ae ,_ ._ ee _ ;ndani + ,-, 602, 6114. De not conn.:ct the Dice <br />we tc•i138 F:-veriy Blvd. <br />// <br />U) <br />E Tk,,>fr•i, ilmcff m :t h. :ut.�•htraaa to a Loof downspout. infiltraiaon system per. <br />f Pv:t:t.tr ,.,i, fntv,l ?-- r.. 7h.% aprroxir:4tt� r,i^..• rren,71h in '.5' wide, <br />and '' r tt, nm t letail« <br />,:iry of Ev cett Stin,iat:ds f•�c small parcels. <br />O <br />,ii r:,r f�I rr4r:•L.1 T from f undati,m, Yi,iS•wnik and drav�,waym she11 he to <br />n,,:.. A:. wa^t 111, . 7 of meter al i. allowed on th:Ls bit i1-:11ng lot. <br />t, -+ t tii h7; l 1 FL1B '7 he tr:r'ked I7T: roadway. <br />N 1I Id i1w in A a1. L'� .Tr 3•: i:9d .:it 11.JeWlik-T 111d 91deWalk0 To be L'.pt :lean and <br />O <br />7i63 <br />O <br />IL <br />SDI 7 /io <br />TO POSTING <br />A;Ooved for Construction I Dqfo <br />as <br />Date <br /><f-z7- /U <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownerlapplicant 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 f m the City and to replace public <br />propertTda t e�,47 <br />Signaturt Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BL 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 (7m) DATAILM INC. <br />