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i� <br /> t _::� :_OG�. �i <br /> �d�e <br /> PUBLIC WORKS � � . �e- '_`' " <br /> Public Works Permit p <br /> PER,�VIIT BuildingPermi�q ' ' �~ <br /> � <br /> PUBUC WORKS DEPARTMENT Planning Reference# � <br /> 3200 Cedar Streel <br /> Fverett,WA 98201 Public Works Fee S , - � � � <br /> (425)257-8810 � <br /> Guarantee 5 � <br /> OWNER NAME APPLICANT NAME <br /> ANDADDFESS: � =�' `� �' ANDADDRESS: , <br /> �"?'iT•j"�:__. . ...- lr.: '_' ' . <br /> PHONE: <br /> PHONE: l:l�L7i�l °.=., � <br /> �TAX PARCEL I.D.N .�� PROJECTADDFESS: . : , - — �'� <br /> �i'I.) ;r.�[il:ii:.j , � <br /> l . `.- <br /> �ESCRIPTIONOF _....__. . , � _.._ . .. . .._i ._ ,.;. .:;. " I <br /> PROPOSED WORK: - � <br /> ___—_--� I�' <br /> --'- —__ I <br /> i <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hours in advance. <br /> 2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. W <br /> 3. Call Location Underground Service 4&hrs. belore you dig.TOLL FREE NUMBER 1-800-424-5555 � <br /> . _ . . . _. . . . ... . . . . . . � , _ _ . _.. ._ .. . . . . . ,. _ . . - _ _ . V/ � <br /> :�y y.�t_i`J o'J � � <br /> �ri r— <br /> �Gr� �a5 � _y�°��.� Q i <br /> � <br /> a; � <br /> i�1 ,s - -- � <br /> � i e, �'� S, lw �u _ p , <br /> �. � � �' -� - ' <br /> n�� � � � � � <br /> ,� ,'I n r�7� <br /> Iw� �v �, �� rQ �` �� ,P� ' ��TL�'."�. v� <br /> ���I�t.Rv� �C1`1 - - _ - -= _ . O I <br /> ��� - G. � <br /> : � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> , , /,� �� , The undersigned owner/applicant hereby agrees ro hold and <br /> - ..y.% - -. /���,� save harmless the City of Everelt from any and all claims for <br /> -�i j/.:,<' _ �`"1 ����=c� damages,cosis,expenses,or causes ot action that may arise <br /> . , ,,, . ., . - � <br /> Appfoved for Conslruclicn `.J Da1e because of installation and maintenance ot the improvement or <br /> other right-of-way use hereto applied for and further agrees to <br /> remove same upon notice irom ihe Ciry and�o replace public <br /> property damaged ihereby. <br /> FINALINSPECTION Date <br /> Approved as Conslmcled _ _ � \ <br /> SignaWreolApplicant Dale i j <br /> I� I <br /> '71i�% <br /> WORK AUTHORIZED 6V THIS PERMIT MUST BE STARTED WITHIN 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED � <br /> 70 COMPLETION.7HfS PERMIT MAV BE CANCELLED BY THE CI7Y UPON ANV S70PPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURATION. DATABAR,iNC. <br /> [P W P O/OG) <br />