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PUBLIC WORKS <br />PERMIT <br />PUDLIC WORKS DEPARTMENT <br />�200 Cetlar Sireet <br />Evcretl, WA 98201 <br />(azsl 257�Paio <br />Date <br />Pu�Gc Works i'ermil a <br />6uJding Pcrmn a <br />Plannin9 Retcrencc a <br />Publlc Works Fec 5 <br />Guaremcc 5 <br />OWNGR hAhl[ Jane� Curr9n APPLIC�NT NAl.!E <br />ANUADUAESS� 3917 �9A SLC@�3C A��DAD�RESS <br />EHERe"'7^i [JA 9S201 <br />PHO�+E Q25Z599353 PNON[ <br />iAxPnRCEIID • PROJECTADDRESS 391? fiigA Street <br />OF:SCRIPTIO�� OF c c . . --.��� <br />PROPOSED Y/ORk �{ /� � � � A" �f ei �,�� <br />�iG r��� T� �r� i <br />PERMIT CONDIT�ONS <br />:/Yi; 2i:05 <br />Prosos-oi't <br />1. All calls lor �nspeclion shall be made 24 hours Yn advanCe • phone (425) 257-8810 <br />2. All wo�k shall be perform<d in accordance with ihis permit and currenl C�ly oF Everett Design and Conslruawn <br />Standards and Speufications. <br />3. Call Location Underground Serv�ce �8 hrs. before you d�g. TOLL FREE NUMBER 1-800•424-5555 <br />4. Haintain an 18" setback from [he Dacl: of the side��lk to tAe ience. <br />5. A gaee shall D2 installe� to oaintain access to th� city e�ter �eter. <br />�iN'�`�- 3-II-6s <br />for consnutlron oalr <br />FINAL INSPECTION <br />A�(IrOVPA d5 CO�SItuCIM Dale <br />$20,00 <br />� <br />:c <br />0 <br />w <br />G <br />v� <br />L <br />v <br />ACKNOW�EDGEMENT OF CONDITIONS <br />The unders�gned ownedappLcanl he�eby agrecs to hold and <br />save harmless tnc Gry ot Everetl Iwm any anA all cla�ms lo� <br />tlamages, cosls, expenses, or causes ol aclian Ihal may arise <br />because ol ms4illauon and mamlenance ol the impmvemeN or <br />other nghl�obway use hercto applicd br and lurther agrees lo <br />remove same upon nonce Irom Uie Gry and ro re0lace pubLc <br />property tlamage th by. <br />���r- �'%� �S_ <br />Sig�u�w a� appbcam _ .. . ----oa�e <br />WO�iK AUTHOAIZE� �V THIS PERh71T hWST BE STARTEO IYITHIN IBO DAVS OF DATE PER611i IS ISSUED AND TNEREaFTEA IS TO 9E DILIG[NiLY PURSUED <br />�O CO�dPLETION THIS PERMI7 MAV BE CANCEILED OV THE CITV UPON ANY 510PPAGE OF \YORN ON T/115 PROJECT OVER 90 DAYS DURATION. <br />