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Date <br /> PUBLIC WORKS PublicWorksPermit# <br /> PERMIT Building Permil# <br /> PUBLIC WORKS DEPARTMENT Planning Reference a <br /> 3200 Cedar Sireet <br /> Everetl,WA 98201 Public'Norks Fee S � � <br /> (425)257-8810 � � ' <br /> GuaR.nlee$ ���I''�v <br /> d I/�SO <br /> OWNER NAME APPLICANT NAME � <br /> AND AODRESS: ��� --"' �"' ' ' "` , '-� AND ADO(7ES5: <br /> - . T� �QSTlNG AUG 18 Z008 <br /> PHONE: y _ PHONE: <br /> TA%PARCEL I.D.N PRQIECT ADOFESS: <br /> DESCRIPTION OF ._ . _.. �;, . .. <br /> PROPOSED WORK: �� � - � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hours in advance. <br /> 2. All work shall be pertormed in accordance with ihis permit and current City ot Everett Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs.be(ore you dig.TOLL FREE NUMBER 1-800-424-5555 <br /> � , <br /> _ }�� <br /> V/ <br /> W <br /> O � <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> j ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and <br /> �` /_ �� , - save hartnless the City ot Everett irom any and all claims for <br /> '� � - �-�'E' damages,wsts,ezpenses.or causes of action that may arise <br /> Appro r Conslruc///tion��� Dale becaUSe ol inslalletion and mainlenanCe ol thB improvement or <br /> � / ?//��J �+ L� � other nght-of-way use hereto applied 1or and lunher agrees lo <br /> �w� �/"� C� remove same upon nolice irom the City and to replace public <br /> FINAL INSP- TION p�OpC emaged thfyEb' <br /> �ppmvetl as Cons;ructetl Date a` <br /> �lY, ��/�/04 <br /> Signature ol Applicant Dale <br /> INORK AUTHORIZED OV THIS PERMIT MUST zE STAtiTED WITHIN tB0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br /> TO COtdFLET10N.THIS PERMR MAY O[CANCRLED�V THE CITY UPON ANV STOPPdGE OF WORK ON THIS PROJECTOVER 900AVS DURATION. <br /> � 6'WPOraGI DAAB�N.ING. <br />