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OWNERNAME <br />ANDADDRC55: <br />PHONE: <br />TAX PARCEL I.D.# <br />DESCRIPTION OF <br />PROPOSED WORK: <br />PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DcPART1AENT <br />3200 Cedar Street <br />Everet�, WA 98201 <br />(425� 257-8870 <br />APPLICANT NAIdE <br />- ANDADDRESS: <br />PHONE. <br />PROJECTADDRESS: <br />PERMIT CONDITIONS <br />Date <br />Public Works Permit N <br />Building Permit # <br />Planning Relerence /! <br />Public Works Fee S <br />Guaran�ee S <br />�� OF��1E.�tt�� _Y/�G,��� <br />_���� <br />1. All calls for inspection shall be made 24 hours in advance. <br />2. All work shall be performed in accordance with this permit and currenl City of Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />. � ,.. c .,.. t �.... ._ .. _ __ � - � . <br />.;irr..-�cr _� Murt t.:�t ::2tf th�� �n 1�:�.,�d:::r.i... in-�, <br />t`....,t r,,.j;.�.. �. }:,,�,� n r_; .., E�t�n�eot. <br />: ii- '?L'''.:1SIl _:Ati" 'lE3�tt�F� d. .=LF'CII�1Cv:j !:S• L;15 _'.i�)l;r ?.1:7.C�:: _..^.(?_..' <br />f�n�- stz<�tirbai � sr31?_ - e[o=;_.n r,i_n{:et;;. <br />:ri ieCf��..:�I�� �?'•,ptYpl:.,._...�'.ir•�?F. ltji��,.. ..�.^.r�t?tI06; C,f ��1�?. �:C�.ieg�'.0 j�C:;l: �O fi <br />_ _ o' th:' p=_�'=t ` <br />. i:1= ,:i•+2iT:�;�� idt=ii,31 iYGu� ..iuil�3ut1G11� ,��1cW31� dO�] rjC1FY.'i�%3 5�13i3 f:�� jlt.':. <br />. ;ip�:.c�v:.,d, pe tin..ti:eci �ite. F�.� laasti.u�, af ivaCrr.�:i:il - � �'�. - . � � ... . .. . .. <br />� i� +t. i..�i.L`� 3hMl":i Sp;7�..^. l'�L .jc.«,i ,.% l.i� li� .Y:.9Ci:c:��. �. . <br />.._. x:C Y.�L111�+_A� �M�it2Ci3_= ��: __. .r�5�7i"�CI C•I LC•g,j: ' . � . <br />ei;er. �fo�� p.;ie��tiian rcaval, - <br />�".� ndii�e:Y. wate.. met.ist tib;t 1" ,Y�uVc. •�az ��.-F+ali- qc;�:i.., <br />;. �. l:BT.tio:� �Jld :-F�.Ci�':e .^UY.1?.. CU.`_�rct: ��::RG ,.+7.�Wdi1' . . <br />f1'SJ J;:�r•?. 5_�'�.'e� Gi1�t}i1PJ K�L'GF�C;=:2:i�i; r1C�:1*.'a.7�+ 39 i!lY�-. � <br />ji.e. >_'i �anuse�i �icice•,l.iV'� 3:1(d z:l�' f.�CC{;311 cr :ix�.a. <br />� . i`i .,;v.>l.. o.'_,rn CiP°• t�'.�7��ir �ifr.��: �t�- -..�.�,:..�a�., . . <br />Approvetl as <br />7 <br />Dale / <br />� � <br />�-�C-c <br />Dato <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicanl hereby agrees to holtl and <br />save harmless the Cily of Everett from any and all claims �cr <br />damages, cosis, ezpenses, or causes of aclion that may arise <br />6ecause of installation and main;enance of Ihe improvcment or <br />other right-ol-way use herelo applied for and further agrees to <br />remov sufie upon notic Iro jhe City artl to replace puhlic <br />prop dy.�±mage, her y. � <br />�% �� ��..� _� �. <br />/` gnaWre of AppliCan Dalc <br />'NORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERfdIT IS ISSUEDANO <br />TO CUfdPLETION. THIS PERMIT M11AY �E CANCELLED BV THE CITV UPON ANV STOPPAGE OP WO(iK ON THIS <br />EPIYP �!-0Gl <br />i0 BE DILIGENTLV PURSUED <br />9J DAVS DURATION. <br />DATA�AR,ING <br />Z <br />O <br />'�^ <br />V+ <br />O <br />a <br />