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i <br /> �����V r���n� Daie _, ..... <br /> Pubiic Works Permit# - �'�.'"---- - <br /> �`��� ■ BuildingPermitl/ �,,,�_, <br /> PUBLIC WORKS DEPARTidENT Fianning Relerecce# <br /> 3200 Cedar Sireel <br /> Everelt,WA 98201 Public Works Fee S <br /> (425)257-9810 � � <br /> Guarantee 5 <br /> OWNER NAME APPLICANT NAME <br /> ANDADDRESS: ' ' � � �` ANDAO�RESS: <br /> PHONE: �' _ _ _ ' _' ' PHONE. <br /> TAX PAPCEL I.D.N PRQIECTAD�RESG:. <br /> DESCRIPTION OF <br /> PROPOSED VJORK: � <br /> PERMITCONDITIONS - f - <br /> 1. All calls for inspection shall be made 24 hours in advance. <br /> 2. All work shall be performed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555 � <br /> � <br /> ��/�� .. : ..�.. . --. , : � �� .� '. .t " ::':: . _, � �.., . 5/� <br /> rcciccp 1 n�c �Lts tc� *+�r drainaq:. �y:st�.,,. : <br /> 1 rcc-:inn � cn*ecl ia...�,ue�:: �,�r rity of F.v.�t,: . : :: m <br /> .'O:'. ICO� i�.,❑ �...�:LT7I ID�?a�Ul'�[:: ll}�riti c,�mpluC:Of1 Of the�pr�7rct ft1;�Z .f.O 41�7d: O <br /> J3_ tll i�eC!._"' ''' .� , . <br /> ' _. _...�uC_] l�aY:'L'i31 -LCL". L���SI7��.3C1�:lir 9��iE'alul}i 3llij ��[1Va_i73�".7 .'+I131y �Va 11•Ulp.� '. � <br /> ,�.�:,co�oer, �'�e.rm�ttt��i� »ita. ..-� �+t�atinq ��f m^.t•�r'iai i:: allo�u on thi:: i�: . ��r+. . . <br /> ... �9i_r.. :ru�i, ::ocl::, or �iet�ei: to ;,�> rLa��l:,=�i o�rto cna:.lua}• � <br /> ' L:i. <br /> .:; t:�iliid2P_7 C:3:23:1dI3 t:• k�c 3�.�CY:<] C;❑ '�^3=.'a:�j 3ft{i C0:��7Y1�y �C bE . . <br /> �_�L' C?111rU1dC 'Y.?V�51. ' � <br /> � � . . . - ., �,,:..,. ". f� � .�. -�pr.,�i�. i�n.� ,-:ut [i� f'r.. :t�r�et pa•d�:. . <br /> ��/� <br /> � . . �. - _ .....�. _ .... __ . _ . . -. . � V� <br /> � <br /> �� ��s�i,b���__�i����� a. <br /> ��----�---- <br /> , /, � ACKNOWLEDGEMENT OF CONDITIONS <br /> The unnersigned owner/applicant hereby agrees to hold and <br /> ���� / /� O / save harmless the City of Everefl irom any and all claims lor <br /> ' ' �� damages,costs,axp2nses,or causes ol action Ihat may arise <br /> orove 'or Consimction ato bccause ol inslallation and mainteno��,ce of the improvement or <br /> /�� / j�/� other righhot-way uso herelo applied lor and ludher agrees to <br /> �r,�t ,`/ Ei remo _upon notice Irom the Ciry end b replace public <br /> FINALINSPE ON p ert)•�damaged�hereby. . � <br /> Appmved a onslmcled Dalo � - � <br /> - �, �--�..i�y�7 <br /> ..._�T:_ �� . _ .. � <br /> SignaNreolApplicanl ate <br /> WORK AUTHOFIZEU BYTHIS PERA9IT MUST BE STARTFD WITHIN l00 DAYS OF DATE PERMIT IS ISSUEDAND THEFEAFTER IS TO BE DILIGENTIY PURSUED <br /> TO COh1PLETION.THIS PEHMIT MAV�E CANCELLED�V THE CITV UPON ANV S fOPPAG[OF WORK ON THIS PRQIECT OVEFi 90 DAVS OURATION. <br /> ePc;r n:ael onrnonn.u�c. <br />