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PUBLIC WORKS Date � � <br /> 7;i�izoos <br /> Public Works Permit p <br /> PERMIT FA0307-026 = <br /> Building Permit p <br /> PU�LIC WORKS DEPARTMENT Plannin�Relerence a <br /> 3200 Cedar Streel <br /> Evcretl,WA 98201 Public Works Fee S <br /> (d25)257-8810 $90.00 � <br /> TO POSTIiVG AUG 12 zoo3 Guarantee5 <br /> OWNER NAh1E APPLICANT NAME <br /> ANDADDRESS�. ANDADDRESS: VICLOC� MtICtSOfI <br /> r'C�, �io-xy�/7v2 nc� �+_ <br /> PHONE PHONE: G�t 2�' (r (�(�� Z a ZU`�' <br /> 92592�3548 <br /> TA%PARCELLO.r PROJECTADDRESS�. <br /> 88 5 . � <br /> DESCRIPTIONOF Inetall culvect a CE and fill ditch <br /> PROPOSED WORK: <br /> PERMIT CONDITIONS <br /> I. All calls for inspection shall be made 24 hours in advance -phone (425) 257-8810 <br /> 2. All work shall be peAormed in accordance with this permil and current City ol Everett Design and Construct'on <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555 <br /> W <br /> 4. 12" stocm pipe ia requieed to Ue instal'�d to COE specificationa including cruahed � <br /> surfacing base course for bedding. A <br /> 5. Install a CB B East end uf clitch and connect the 2 9" drain lines into it. Connecx. V� <br /> the 12" pipe into it a� well. <br /> 3. Use caution digging neae the two vatec aervices that cxoss this area. m <br /> 4. Call the Public taocks Ins�;ectuc l� 425-339-74U4 tu sch�iule a PRE-cunstcuction O <br /> �=unference. <br /> � <br /> Z <br /> �_ _ O <br /> G�i� � <br /> :it '^ <br /> i'Rl ^ H/ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � AI � /� n The undersigned owner/applicant hcreby a�recs b hold and <br /> � U save harmless tho Ciry ol Everelt Irom any�nd all claims for <br /> rovra ior Conswcaon me dama9es,costs,e�penses,or causes ol action ihal may arise <br /> becauso ol installation and maintenance ol the improvemenl or <br /> �/!/ �J /� other right•obway usa hereto applicd lor and lurther agrees ro <br /> /��-1[ /�� ���W�"'� �'� "� -�� remove same upon notico Irom tho Ci�y and to replaco p 61ic <br /> FINAL INSPECTION proporty dama Iherc <br /> A mvetl as Consimt�etl Oain � 7 <br /> � �ca� ,�TZtl�s—� _�7 Q3 <br /> Si9na ure olApplican Date <br /> WORK AUTHOPIZED�Y THIS P[RfAIT MUST oE S7APTE0 WI7HIN iB0 DAVS OP DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE MLIG[NTI.Y^URSUED <br /> TO COUPLFT10Y.TMIS PEP1dl f M11nY 8[CANGELL[O�v THE CIiY UPON ANY STOPPAGE OF YlORK ON TI115 PPOJECT OVER 90 DAYS DURATIOK. <br /> 1 <br />