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� ( Everett <br /> � <br /> PUBL/C I�VORKS 1 I I � <br /> ` t ENGINEER/NG/PUBLIC SERV/Ci,S DEPARTMENT I I ' <br /> ., <br /> 2002 <br /> co��•it,�c��'OR RECIS7•�iA'TION I?\GMPTION <br /> OWNCR I_� � I� -1 ��'r '>��n��„ �� <br /> P�RMIT # ��OS/v - oyCo �� o •�,f� <br /> � � <br /> PROJEC'T AnDRESS �>.a7 � �Q-��� v �o�-- <br /> l indcr Ihc Slalc RC11' Scction 18.27.091i "13xcmpiions", as o�cncr of thc aboec- <br /> rc�cr:nccd propcily. 1 ���ill acl as Ihc gcncral contrac�or for thc ��ork undcr thc aho�c- <br /> r�fcrcnccJ pernii� and hcrchy ackno��'Icdgc thc lollot��ing: <br /> I. l�hc constructiun rrla�rd �o IF;c abo�c•rcfcrcnccd perniit is not hcing Jonc�cith ihc <br /> prescnl intcnlion ul�sclling Ihc improccd pruperty. <br /> �. All ��ork ��'ill hc durc h� Ihc Icgal o��'ncr(s) of ihc properl��. or rcgistcrcd <br /> contrac�urs. or nn� full-Iinu cmployccs. <br /> I h:rvc read nnd :�ckno��icdcc ihc :ibncc informalion. <br /> -� <br /> -�1�/ .���_ -���"� -- <br /> O�cncr's Sign:fttirc — --- — Uatc <br /> Please Pri . Signatory <br /> � • <br /> � � <br /> Name /->,ac �����-- ".; y� <br /> CITY OF FVLR[TT • 7200 Cedai Street • Everelt. WA 98201 • (425) 257-8200 • Fax (425) 257-8856 <br />