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Date � <br /> �UBLIC VIIORK.� puGlicWorksPermit# <br /> PERMIT I BuiIC'ngPnrmitK <br /> I� PUBLIC WORKS DEPARTMEIdT Planniny Raterence lt <br /> 32J0 Cedar Sireet <br /> Everel�,WA 90201 i Public Works Fee 5 <br /> uEF lazs,zaz-aq,o <br /> TO ���71NG..._.___:..�;..::��:: J Guarantee5 — <br /> OWNER NAME APPLICANT NAh1E <br /> ANDAODRESS � - ANDADDHESS ' - '. - - , - , <br /> IPHONE: �. _. - ' �'_ . PHONE: . . . . . . - - I <br /> THXPARCELI.D.k . . PRQIECTADDFiESS: <br /> CESCRIPTIONOF . . . . <br /> PROPOSED WORK: � <br /> I <br /> �. -- — —_ <br /> PERMIT CONDITIONS � � <br /> 1. All calls for inspection shall be made 24 hours in advance. <br /> 2. All wurk shall be perTormed in accorCance with this permit aM current Cily of[verett Uesige and Conslruction <br /> Standards and Specitications. � <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800-424-555� L <br /> r <br /> V� <br /> i � :-c+�t u;.a u �� _ E.�r � �t}� �. avec�_tc ,i ani.ac �� :�c � <br /> �i� .ont� �. .,�3� �o , np_,� �nmT��lc�ti �� ;�f th Frojc�r p�-i. , . <br /> . " pcLm1L. O <br /> , . . 5-i P13C5i131 �.`.CCIL i�._��1R�idL1^I7� i1�E'./dlE: 3R�.� nL'l'r'cV3�J:i 3(lg:.l ��? {1.9': � <br /> -v•:.u; �.�eCIDiltFr� 87tE•. }IG N33t]Slq GI lO:ICE•1'1&] 1� 311Ui-�C•:1 OTI Ch19 bllilC�1` . <br /> ie!, �iuti� t'c;�ks+ Or dr-1`[:.^, t�7 he- tC�icke�.i ^��N;o Coad�.a}'. � <br /> . h'1_�_1i7�7 4l3?n'131= -n k,c ••I3r'}:?:I (iIl 3�+!<_'.73i}:s nmi �xc�?vall_� co h:� �;_'p2 � � <br /> �i for �:�,i?str.sr. ceav.at.. <br /> i�st u'st t i -� . ti lc.r "' +LnS�E -�i ipu._i11; .�e�aciu. <br /> . and t � ' .��> � u�",, <�nrT.,-r ann .n.dava �.t� aP per C'i^.p of F_vwr.:•« ,•..a�,�: . '"�' <br /> �0�: on *hie prc:Fc,^�1; !•:cnt�q� as dir��ceci hy th_• Fvb' _ � <br /> ., ..� a � _ .<. i5a and an) 'ac�_.„:.n ._ � �j _:��� .:� a .=a-* !,;. . . <br /> � .h:- f u,nt � ,:�p.:- � .. �. . . O <br /> i� <br /> �, - � - � � � � � ACKNOWLEDGEMENT OF CONDITIONS <br /> // The undersi3ned owner/appticanl hereby agrees to hold antl <br /> .,�% y'�/�����' �a �,¢ Q � save harmless the City ol Everett Irom any and all claims lor <br /> i � ��� damages,cos;s,expenses,or causes of action thal may arise <br /> � n(ipmve r Conswction a�e because of installation and mainlenan�e ol the improvement or <br /> � 7 other ri9ht�ot-way use herelo applied lor and lunher agrees lo <br /> -����` . <br /> �`�`� '� / re,nove same upon nolice Irom ihe City and�o reptace puUhc <br /> � Ii1JAL INSPE ION pn�jefiy dBmaced Bialeby. <br /> Appwvetlas onslrucletl Date �� ' , . � , <br /> ". �i :` - .' � . <br /> .� / <br /> _ S�gnatureolAppfcanl Uate <br /> :�il <br /> �F,t,tRHnRIZ[U[3V THC9 PF.R.•All C'UST PE SiARTE�WITHIN 1800AVS OF OATE P[Rh9T IS ISSU[D AND THEREAfTER IS TO BG OILIGENTLV PUf7�U[D <br /> ICC.�J:'FLEIICN THISPEHf.11lLtnl'LL'c'PNCCLLEDBVTHECITYUPONANYSTOPPAGFOFI'1JRKONTHISPRCJECTOV[R90D0.VSDURATION <br /> . .. ,.,, onrn�nrv.ir.r <br /> � <br />