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PUBLIC WORKS �a1e ,
<br /> Publ�c Works Permit q `"'�i F,._:��.-
<br /> PE R nll!T Building Permit#
<br /> PUBLIC WORKS DEPARTMEhT Planning Relerence k
<br /> 3200 Cedar Streel
<br /> Everett,VIA 98201 Public Works Fee S
<br /> (425)257�8810 �
<br /> Guarar.tee 5
<br /> OYlNERNAME � , APPLICANTNAME
<br /> ANOADDFESS: � — . .. � � ��.. ANDADDRESS:
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<br /> _. �: - . T� POSTING..'..:.::__ _�.
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<br /> PHONE: , � PHONE .
<br /> TA%PARCELI.D.# . . PROJECTAD�RESS:
<br /> OESCRIPTION OF �
<br /> PROPOSED WORK: .. � .
<br /> PERMITCONDITIONS �.:_ . `�::: .-��� �:_.. - : - � - � - � -
<br /> i. All calls lor inspeclion shall be made 24 hours in advance.
<br /> 2. All work shall be performed in accordance with Ihis permit and currenl City of Everett Design and Construction
<br /> Standards and Speci�ications.
<br /> 3. Call Localion Underground Service 48 hrs.6e(ore you dig.TOLL FREE NUMBER 1-800-424�5555 �`
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<br /> . . .- ._-. . : . .. :� ._ ��,:- _-�- . .____... � _ . �:_. �.�_.. �::--' ��/y
<br /> .,.- ,- ,.r�:�t �.�� �c i�- -:-�l:si *- . _: � ��. �� _ -..,� }� �_ ;n � .: ,-�.:._.-. y�,� V�
<br /> � ererr Stnr.m Mannal ±-'.F.i. ?ne ap�±ci�timate ;Z � r_L�n h i . . .5 w�ar, �' �;. /��
<br /> ' � 5• lOOr�. $ea. 9ttsche;nnt fn[' rnoY'c� dat.ali::. ' W
<br /> -::a::=a?1 ac,,:�:on c.;nr��,� ,��anuce:; �,e� Ciry �;i uverett 5�3[l�j3l'�i.+ Ir�C �uall pac�_._. .. O
<br /> . :io clict, mud, �ecF:s ur uebiis tu be t[ael:ed unt�� CoSdaay.
<br /> . .,:�� buildinq marerials t!� i�e st:arkerl nn :idewalke, and ;i�:evalk, r„ he ke�;t c� . �
<br /> . . -.pen tor. pedFstc..ian tr.;rv�l.
<br /> . Cor,cs�^t rhe hlul:ilr�o ❑c,ter �itrict foe connuctinc prcr,�;sy:ms ier `nis _ . . . . � Z
<br /> . ._ and sF.�ec s�cvi� ��.
<br /> � .yri;ust �rade ind rair� w:rt:rr mot�e bnf lt�:.`.�-.,. . . .. . -, .. - . � - - . �
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<br /> ACKNOWLEDGEMEN�i OF CONDITIONS
<br /> '. ' ` The untlersigned ownedappticant hereby agrees to holtl and
<br /> /�— �/� sava harmless the Ciry of Everett Irom any antl all claims for
<br /> � damages,costs,exponses,or causes ol action that may ari,e
<br /> A provetl lor slmciion �- Dalo
<br /> � because of instalialion and maiNenance ol the improvemeM or
<br /> ���/ � SI/ olher righl-of�way use hereto applied for and luriher agrecs to
<br /> Jemove same upon notice Irom the Cily antl to replaco public
<br /> INS ECTI—O�=— �propertydamagetliheroby. ^
<br /> A;�PwvetlasConslructed Dato . I�.
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<br /> T^ 3 7 SignalurealAPPliwnt . -�/' � ..�O�to
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<br /> W ORK AUTHORIZED BY THIS F�RMI7 MUST BE STARTED 4VITHIN 1 BO DAVS OF DATE PERMIT IS ISSUEO AND THEREAFTEF IS TO BE DILIGENTLV PlIRSUED
<br /> TO COMPLETION.THIS PERIAIT IJAV�E CANCELLED BV THE CITV UPON ANY STOPPAGE OF W ORK ON THIS PROJ[CT OVER 90 OAVS�URATION.
<br /> CPWP(]A4) JrUA[1M.ItiC
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