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PUBLIC WORKS Date <br /> Pubtic Works Pertni�N � � ' " <br /> PERMIT Bu��dingPermita _ �:__ - `_ <br /> PUBI.IC WORKS DEPARTMENT <br /> 3200 Cedar Streel Plenning Reterence x <br /> Everetl.WA98<"Ot <br /> (425)257-8810 Public Works Fee 5 - :_ . <br /> T� bQSTING �8 GuaiaNea 5 <br /> OWNEfi NAME APPLICAN'f NAME <br /> ANDAODRESS . '. �� . . � ANDADDRE�S: <br /> _ ' "" "" �_ ��- P� <br /> _. ,'=.�F:E'I^ -.. ._ . . <br /> PHONE: , - PHONE: <br /> TAX PARCEL I.D.X _ PR0.1ECiADDRESS: <br /> i.; ��., <br /> ' _ i'i.. <br /> �. . . . _�. .� y:. . .�. 4,� <br /> DESCRIPTIONOF ...._. ..-.- . . .. .. . ... . . �� . . ... <br /> PROPOSEO WORK � �� � �� - . - , - <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shell be made 24 hours in advance. <br /> 2. All work shall be per!ormed in accordance with this permit and current City a(Everett Design and CcnstrucCon <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 40 hrs.before you dig.TOLL FREE NUMBER 1-800-024-5555 W <br /> � <br /> _ _ : ,. . . . . .. . � <br /> _. . ._.. : 'A <br /> - — ::_-- _.., ...-:. V/ <br /> . . _ _ . - ' - ' L'�r"'`3i m <br /> a ,��. Q <br /> 2J � <br /> Z <br /> � p <br /> �., <br /> �,� F— <br /> e <br /> ��u�: � <br />�il� � `~�L O <br /> a <br /> i _ 'L'� — ---- ---- ACKNOW�,EDGEMENT,OFCONDITIONS <br /> Th rsigne�owneriapplicant hd�eby agrees to hold antl <br /> / � ,,,,�� � � Q, vo harm the City ol Evoretl Irom any and all cl2ims�or <br /> Ap ov or ,ons�mnion �e damages,co s,e or causos oi action ihat may adse <br /> 1' beca�se ol in tion antl �aintenance of Ihe improvemen�or <br /> � / LJ ^7�] �lher nght-oi- use here appliod lor and lurther agrees to <br /> L" `G�( � emove sam p no�ice mm Ihe City and to replace pu61i,; <br /> FINAL INSPEC iiopcity da ged ih <br /> Appmvetl as slruclea Oam � ���D � <br /> Signatur �tan pf <br /> WORN AUTHORIZE�BY THIS PERIAIT MUST BF STAFTED WITMIN 1Ba pAVS OF DATE PERIdIT IS ISSUEO AND 711EREAFTER IS TO BE DII IGENTLV PURSUED � <br /> TO COIAPLF.TIOId THIS PFfildlTl.1AY Il[C4N�[LLED f3V THL qTY UPON ANV SiOPPAGE OP WORK ON THIS PROJECTOVER PO DAVS DURATION. ' <br /> O�dpBAR.IHG <br />► <br />