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PIiBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streot <br />Everetl, WA 98201 <br />(425)257-8810 <br />AND ADORESS:� .. . - ., ..... <br />PHONE: . <br />TAX PARCEL I.D.N <br />�.,j�_�. -'��ii_'y(R�. — <br />DESCRIPTION OF .,, _.. _ - <br />PROPOSED WORK:" . . - . . � . �. <br />PFRMIT CONDITIONS <br />PHONE: <br />Date - . _ -, _ . . <br />Public Works Permit'A' ��� � � '� � <br />Building Pertni� 8 <br />Planning Reference # <br />PuWic Works Fee $ . . "" <br />Guarentee S <br />PRQIECTADD9ESS: .-_'.,_" , ' — <br />1. All calls for �,.�pection shall be made 24 hours in advance. <br />2. All work shail be performed in accordance with this permit and current Cily of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-800-4245555 <br />J <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedappticant hereby agrees to hold and <br />save harmless the City of Everett from any and all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because of installation and maintenance of lhe improvement or <br />other right�of-way use hereto applied for and turther agrees to <br />remove same upon notice from the City and to replace puhlic <br />prcperty damaged thereby. <br />SignatureolApplicant Date <br />WOFK AUTHORI2ED BY THIS PERMIT MUST BE S7AFiTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER �S TO BE DILIGENTLV PUFiSUED <br />TO COMPI ETION. THIS PERMIT MAY BE CANCELLED �Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURATION. <br />EPWP (�/06) DATABM.INC. <br />W` <br />I"� <br />'�A <br />V/ <br />� <br />O <br />� <br />Z <br />O <br />F- <br />� <br />O <br />a <br />