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� <br /> PUBLIC WOR!(S I Date 9j..;_nii@ <br /> PublicWaksPermitq ?WOB04-��'�'_ <br /> PERMIT BuildingPermitN Fngn3_i:,�. <br /> PUBLIC WORKS�EPARTMENT Planning Reterence k <br /> 3200 Cedar Sireel <br /> Everett,WA 98201 Public Works Fee S c�5,i��� <br /> �a25)z5�-eei0 <br /> Guaranteo S <br /> OWNER NA1.1[ APPLICHNT NAME <br /> ANDADDRESS: !�J�'r;C�'; FI�`i`t�-:l� ANDAODRESS: <br /> 2015 GkANU AVE <br /> EVERETT WA Q8201 <br /> PHJNE: PHONE: <br /> TA%PARCELI.D.p PRQIECTADDRESS: <br /> oo43�a92�po90 � :�15 .::-.t,[� ��� <br /> PFOPOSEDWORK: T�Q GAFJIGE (H!'O:i�-f.�9'? <br /> ,; _ 11_-(_Z_°� <br /> _- 'S'o` �`� �`�c.� f l` ? -� <br /> PERMIT CONDI710NS <br /> 1. All calls for inspection shall be made 24 hours in advance. <br /> 2. All work shall be pedormed in accordance with this pertnit and current Cily ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800-424-5555 `W <br /> 1""� <br /> � <br /> �. . .. .:':: C'CJS].G❑ C011tlpl ID�3�ULu5 53 det=enin=d t�}' C}):- 1Ub_it� ' : �'r:� in�p8�7201. £if:']: r^ <br /> � : 1` femc=, 9tCdW hdl?9, ;V31F3, OC @C0916R blanket2. n �� ��� <br /> . �cc�vF %'YC1gl��f1 c"ntrnl ifie33UCPS llpcm completion uf tAe pcoject pe3z��� fi�al �' � <br /> coval of the p?rmit. n,=.;t �= - <br /> v« O <br /> �. NO �1CC� mUd� CGC�t9 OC ��96C13 CO VP_ trarked OI1C0 iO3�M3}7. f*i `��ni:�� " <br /> . No btuldinq material� tc� be �ta^.ked in alley and alley to be k�t�t clean ar� .�{,- �. � <br /> •, <br /> ' r VP_h1C1? LC<iVe?1. � - <br /> . ra��e tjC1Y?W3Y YTOID the fr�_nt peop=_rty line out to the atreet pavina. ''� � Z <br /> , __ , . . , . , .. . . O <br /> _ . _ . _ _ ... _;ar j <br /> .L ��� a� w <br /> ..i r.� _/ <br /> i_ <br /> O <br /> a <br /> � ACICNOWLEDGEMENT OF CONDITIONS <br /> , ,t, The undersigned owner/appGcanl hereby agrees to hold and <br /> I -�,// / J_ . �1 �_-;� save harmless ihe City of Everett Irom any and all claims for <br /> � Q'���f� damages,costs,ezpenses,or causes ol action Ihat may arise <br /> � A ed Construcbon///''' ^ ale because of installalion and maintenance ol lhe impmvement or <br /> / .�'�j � /_D Q other righl-of-way use here'c applied br and fuhher agrees lo <br /> ��--, Q remove same upon nctice Irom�he City and to replace public <br /> �� � �� <br /> �� FINAL INSPECT FmpCtl m• d Ihe�by. <br /> Approved as C slmcted Date <br /> �' ��%�.�i�a--- 'Y-�E: _o� <br /> , . _ SignatureolApplicant Date <br /> \'JOHK AUTHORI7E0 6Y THIS PERMIT MUST 8e STAFTED WITMIN 1B0 DAVS OF UATE PEH611T IS ISSUED AND THEREAFTEF IS TO BF DILIGENTLY PURSU[D <br /> TO COMPLETION.THIS PERMIT MAV BE CANCELLED BY THE CITV UPON ANY STOPPAGE OP WORK ON THIS PPOJECT OVER 90 DAYS DUFATION. <br /> i rwr pia� <br /> D4tApnR.ING <br />