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PUBLIC WORKS Date <br />P����� l �' � �: Public Works Permit q <br />"t�'i +�1: �.4 Building P�rmitll <br />PUDUC WORKS D PART�yf `'T 1 <br />'�i , ��T��7(}� Planning Rclerence a <br />3200 Cedar Sh�et'' ' <br />Evcren, WA 98201 Public Works Fco S <br />(425JE57-BBjO I�'ii'jf; N.Cj':'.'-`� <br />ij Guarantec 3 <br />• nn r; n � , ,�... .�.-. <br />OVJNER NAME <br />ANDADDR[SS: iI_,/.� / <br />/7�/'1 � �r '� <br />PHOLc. <br />I.D. a <br />�1Y�MC , � <br />I . t ti� AND ADDFlEyS ,� <br />,l. ; e. �:i �' � � ._ �)!} <br />l'4�I E '����,'�L�'1 <br />PHONE <br />LONTEF;kA A?:V��; <br />19217 214TH FL SE <br />S NOHCi�lI SA <br />a�r,�ai�5�s <br />_�° DOFH <br />s�si: �oes <br />FW05��; ii_�; <br />$5�5:2.ii0 <br />aB�`.�b <br />D[SCRIPTION OF - �' -"""" -� <br />PRGPOSED WORK: �0 �/�STlnf(� JAN 1 T zOO6 <br />�a� 1 A11�4 <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with this permit and currenl City of Evereu Design and ConstrucDon <br />Slandards and Specifica�ions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />1. FEk APPR4VED PLh1lS uAT'Ep 5-Zt`•-Uti <br /><'�--�,_'�' _. �T ' � T� —�1 % 'c` ' �. <br />C��� �< . . �-� I - CJ �, � <br />�--�_. �— <br />ACKNOWLEDGEMENT OF CONDITInNS <br />W <br />� <br />V+ <br />m <br />0 <br />� <br />Z <br />O <br />_ I <br />O <br />a <br />The undersigned ownm,applicnnl heret�y ac�rees lo hold and <br />^- r :�i� � �' �'% r' save harmless lhe City ol Everett Irom any and all claims for <br />pp ov or Constm ion Oate damages, costs, ezpenses, or causes ol action Ihat may arise <br />because ol installation and maintenance ol Ihe improvement or <br />yfi `_/� `� '/' other righ4of-way use hereto applied lor and funher agrees Io <br />�'C`��t remove same upon notice Irom Ihe Cily antl to replace public <br />`�F'1 AL INSPECTION \ prop�dama c Ihcreby. <br />�pp�ovM as Conslmcictl Date �( <br />: 2 — � C ^ c7� l \ .� d..,, ,.�' � ji �1 /,'. <br />!i� <br />Sig I Ap � �� Date <br />IVORK AUTHORIZED �V THIS PERMIT A1UST �E START[D WITHIN 180 OAYS OF DATE PEflMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br />70 COGIPLE710N. THIS PERMIT h1AY �E CANCELLED BV TH[ CI7V UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />