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, <br /> Date <br /> PUBLIC WORKS PubGcWorksPermit# <br /> PERMIT � BuildingPermil# <br /> PUBLIC WORKS DEPARTMENT Planning Reforence N <br /> 3200 Cedar Slreei O„ <br /> Everetl,WA 98?Ot �W � Public Works Fee 5 � <br /> (425)257-881p I �GS� 1 . . . _ <br /> p� � �b'� Guarantee 5 <br /> !/'• <br /> OWNER NAME APPLICANT NAME --� <br /> ANDADDRESS � � � <br /> ANDADDRESS - :.,. .- _.. ---.. , ., ,-. <br /> _ . _ .. . _ . . . _ .. �"_ . ' <br /> . .. ... . .._..__._ .I:. ' <br /> PHONE: .._ . __ _ _ ' , ' PHONE: . . _ _' . _ ' <br /> TAXPARCELI.D.N , � � , PRQIECTADDRESS: _ ///, �.�AF-��)� (, I/,�� <br /> �V7 l� <br /> ;lAilii"'�ii.'i J <br /> DESCPIPTION OF . . . .. . . - �-���-s-��.}�_5-�-. <br /> PROPOSED WORK � - � � � � � <br /> PEFMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hours in advance. <br /> 2. All Nork shali be performed in accordance with this permit and current City of Everett Design and Cons�ruction <br /> Standards and Specifications. � <br /> 3. Cali Location Underyround Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800-424-5555 ` <br /> r <br /> _ � <br /> .._... '�Li.. . . _ _ _ .Ic' _�.(i� :�:.�. ': _ L ' u. _ � �C�:!..�..1 - , ...._.. . N <br /> ;z;:_ap.ng pla�ie mu�r be a�:perv,>�i �,rioe to L,u:iding fFcmit i�euance. M <br /> _ . . ._ , <br /> W <br /> ,_.._ , O <br /> � <br /> Z <br /> O <br /> � <br /> N <br /> O <br /> a <br /> � - — — - ACKNOWLEDGEMENT OF CONDITIONS <br /> /t{ � � The undersigned owner/applicant hereby agrees to hold and <br /> � _�-�� //� GS C. ki save harmless the Ciry of Everett Irom any and all claims lor <br /> ��V`� Z � damages,cosls,expenses,or causes ol action thal may arise <br /> ppro or Con trucuo� a�o becausu of inslallation and maintenance ol the improvement or <br /> / ///'� 4 other righl-of-way use hereto appiied for end fuAher agrees to <br /> � �(„� J ��' -Ci� remove same upon notice Irom the Ciry and lo replace public <br /> ' fINAL INSPEC �ON property damaged�hefeby. <br /> Approvod es onstructud Dalo � <br /> _/��6 <br /> B. �� re al APPIicaM Date <br /> W OfiH AUTNOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TG BE DILIGEtJTLV PURSUED <br /> TO COMPLETION.THIS PERMIT MAY DE CANCELLED BV THF CITV UPON ANV STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURATION. <br /> [PYJP�)U6) DA7ABAP,ING. <br />