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�� � <br /> Date I <br /> PUBLIC 1MORKS PublicWorksPermita - <br /> PERMIT BuiltlingPermita :;rf�;. __ <br /> PUBLIC WORKS DEPARiMENT Planning Reterence p <br /> 3200 Cedar Stmet <br /> Everett,WA 98201 Public Works Fee S <br /> (425)257-B810 _ . . <br /> Guaranlee 5 <br /> OWNERNAME APAUCANTNAME <br /> ANDADDRESS: ANDADDRESS: <br /> , , ,:, -,,-�,,�F�h7� �;� . ��b `POSTINC��u�a i � �ool <br /> .� �. ...�•wHY ............._...._..__.. <br /> _ .._. _. wt, 9A��:'_ <br /> PHONE: PHONE: <br /> - ;��a7ri ,c � ...; <br /> TAX PARCEL I.D.N~. PRQIECT ADORESS:� <br /> -*..y� <br /> DESCRIPTION OF � ' � - -- �- - . . _....._ ... <br /> PROPOSED WORK: � �� - � - � � � - <br /> PERMITCONDITIONS - ---. . . - -_-._ " -.... -- <br /> 1. All calls ior inspection shall be made 24 hours in advance. <br /> 2. All work shall be performed in acwrdance wilh Ihis permit and wrrent City ot Everett Design and Construclion <br /> Slandards and Specificalions. � <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555 ` <br /> _ , ,.. _ .. . . .. ... . _ <br /> r <br /> , . �.�.;,�..,, ... - � ' _ .. _ . �- _' -: - � <br /> :�•. : <br /> .. ' ",�:.. _ : __.-. . .. -. . . -?�'''' c-i"f; T):'.F.-,. ,�r�...`:9 i}!f THI` . — ,._ _. � <br /> _ O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> — - ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees�o hold and <br /> / save hannless the City of Everett from any and all claims br <br /> C��F��fy �,« ��� damages,costs,azpenses,or causes oi action that may arise <br /> Ap vea lOr Conshudion D� e because ol inslallalion and maintenance ol Ihe impmve�nen�or <br /> 7 <br /> iN��� / �f /� „ � othnr righl-ol-way uso horeto applied lor and IuAher agrees lo <br /> `C v- rv ��� remove samo upon nmice Irom the Ciry and to replace puhlic <br /> oN propedy damaged Ihereby. <br /> Approvedas onslmcted ale . �LC3�o b <br /> �`-�'�-_`� 9 � <br /> ___ Signalure ol Applicant Date <br /> WORK AUTHORIZED OV TF ;PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUE�AND THEREAFTER IS TO OE DILI�ENTLV PURSUED <br /> TO COMPLEiION.THIS PERMI f MAY BE CANCELLED BY THC CI7V UPON ANY STOPPAG[OP WORK ON THIS PROJECT OVER 90 DAVS DURATION. <br /> EPWi'Il/OG) �ATApAR.MC. <br />