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�� Everett, WA 98201 <br />(425)257-8870 <br />IEfl NAME <br />ADDRESS' i'7.TY i�P G�.'FT<F.T�P <br />:'.,: qp "LDAF: ST <br />r.:'.`�AS,TT :?� '�P�`�l <br />FHONE: Q� j; ti7yQ(10 <br />TAX PAPCEL I.O.# <br />Public Works Fee $ <br />Guarantee $ <br />ANDADDRESS: A�'�!LiEf1 Yk��F SEF.':ICr::: :}�f <br />q;5?p SE tIL��*.:'� PEtID aY <br />HC_RTH L'�}iD k,'., : ���q5 <br />PHONE: ,+�';���j�;)(i;, <br />PRQIECTADDRESS: <br />kUC7fET: fiILL (`_'.F.E GLSC.1 <br />DESCHIPTION OF <br />PROPOSEDWORK: "I`''-�G LC+'A7TOt7C <�"i SL47.�.'F: �1 h�hTER l44IN I*i BOti <br />E'LDFThL A'vi: n:.lbliti -:3!?D �":�' �, '�P�iF:F.C'. P�1�� y.i,i..T �1:ySt_,F.`: a�.�ccl� L.. <br />PERMIT CONDITIONS <br />7. All calis tor inspection shall be made 24 hours in advance. <br />2. All work shall be pertormed in accordance with Ihis permit and current City ot Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />`:0.;�;• <br />. ' �-! f::_' _' � 5!: �,in�.v .:!��rF.e: ._�:L _�h.lt � 3*...1: i�=_� ^.;t_•; �-•r E:,���r* 3tan�ia��i, <br />� r!'UV/dC% �i"lr7iL C�h�"YU� f�'.�' ���C'� �I�lli.f� C�ni:� rr5 i�ivt_L�:c� <br />t <br />u� �l�c G��fy ;�;�h(�� C:�a.-fy �i%Sne�1��r <br />r <br />_:-Ji.�� :t,. i �Y7•�La,�(a'.'-�._- .J'�/4-�/I �(! <br />�\ Appwved br Constmclion Uale � r <br />FINALINSP T N �, �Z O _ <br />Approvetl as nslmcled Dale <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold end <br />save harmless the Ciry of Everetl irom any and ali claims for <br />damages, costs, expenses, or causes of adion that may ansa <br />because af installation and maintenance of the improvement or <br />other right•ol-way use hereto applied lor and further agrees to <br />remove same upon notice irom [he City and to repiace public <br />pfopeAy damaged thereby. <br />i IJ�; / . � ,� <br />L'1bii,'�`�.�/Ls�l ._._ :•-, �.. :i <br />SignatureolAppliwAt Date <br />WORK AUTHORIZED BY THIS PERMIT h1U5T BE STARTED W�THIN 180 DAYS OF DATE PERMIT IS ISSUED AND TH:REAFfER IS TO BE DILIGENTLV PURSUED <br />TO COMPLETION. THIS PERMI7 MAY BE CANCELLED BY THE CITV UPON ANY STOPPAGE UF WORK ON THIS PR0.IECT OVER 90 DAVS DURATION. <br />EPWP PN6) DATABAR. INC. <br />W` <br />r <br />N <br />� <br />� <br />Z <br />O <br />H <br />� <br />O <br />a <br />