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PUBLIC WORKS Date 3�Q�QI <br /> Pubiic Works Permit p ��03�Q �3 <br /> PE R M 1 T Building Permit p <br /> PUBLIC WORKS DEPARTMENT Planning Reference M <br /> 3200 Cedar Slreet <br /> Everett.WA 98207 Pub�ic Works Feo$ Z� <br /> (425)257-8870 <br /> Guarantee$ <br /> CWNER NAME �/ /� APPLICANT NAME <br /> .4NDADORESS. ��� ��7Y"IO ANDADDRESS: <br /> V '^'K/ <br /> (�G p�rozd w�+� Aue �C <br /> K,10NE' PHONE <br /> TA%PARCELI.D.M PROJGCTADDRESS: //�'] ���,� �L <br /> ((tt.(/'1 [J <br /> PROPOSEDWORK: I�IJ�lC �j �hi��l f�/�.� �1�v� <�l( 7^ f�yh� D-F wr+c� Glyd <br /> �tin�-' sl�r'�/.�.�°irt� . � <br /> aJ <br /> PERMIT CONDITIONS _. . . <br /> 1. All calls�or inspection shall be made 24 hours in advance-phone (425)257-8810 � <br /> 2. All work shall be perlormed in accordance with this permit and current Cily of Everett Design and Conslruction <br /> Standards and Specilications. <br /> 3. Call Localion Underground Service 48 hrs.before you dig. TOLL FqEE NUMBER 1-800-424•5555 <br /> /�, A3 �xr aPp%n�cd pl�n d��ed 3/iz/o� H <br /> 5 Ke� Gi� S�G�S �le�� �� �il �,'M(y . � <br /> �P� {��D p��,Q� ���ii'! y ., ll ��r�To,-� is �'Jo� Ta �.1/c�, O <br /> 1 � � /� 7 <br /> 7 l�fax� n���► war� �ie,�9h � �s 3 : Z <br /> �• y� /14-f 0.�S7+v�'C- crGG e15 �O S�'� �'1 o�n 70�2. O <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> G � The undersigned ownedapplicant hereby agrees to hold and <br /> save harmless thrt Ci;���Evemtl irom nny ond all claims tor <br /> a pr vea ro�C ucuon Daie��� tlamages,costs,expenses,or causes ol action that may arise <br /> because oi installation and mainlenance of the improvement or <br /> - / � \\ other righbol�way use hcreto applied lor and�lurther_a�Q�rce_s t�o <br /> _(1� V remov�same upon notice Irom Ihe City and b rep aTpuUr <br /> FlNALINSPECTION opertydamagedth.r �y. <br /> App�oveDasCons�mc�ed Dale <br /> �:�y�.� ��/_��a)_ <br /> Signawre ol Appin;am D ie <br /> l•;ORK nU7HORIZCD[3Y THI:PCR6a171.1U5T(3E STnR7ED�•✓ITHiN 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO�E DILIGFNTLY PURSUED <br /> ;O CO!'Pl L11UN THI;PEH'.11T t.1AY U[CANCCtLCD�V IH[CITV UPON AIJY SiOPPAGE OF WORK ON THIS PROJECT OVER 90 OAYS UUfiATION. <br />