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� � <br /> Date -=.'4!•'_0�7 <br /> PUBLIC WORKS PublicWorksPermil# PW��12-001 <br /> PER M 1 T Builtlinq Permit# <br /> PUBLIC WORKS DEPARTMENT Planning Relerence# <br /> 3200 Cedar Slrect <br /> Evoretl,WA 98201 Public Works Fee 5 ;25,90 <br /> �a2s12s�•eyj9��i�� DEC i f ZO�i Guarantees <br /> OWNER NAME APPLICANT NAME <br /> ANDADDRESS: Y32fi1��❑ Eh1tZi�3tCiCF: ANDADDRESS: .IdCk Y.PCPtt� <br /> 103:+ <:�akes Avenu� 1710q 24th pl. N.E. <br /> Everett Wa 7'8118 Snohomish +�a ?8290 <br /> PHONE: 'nFaqg133q PHONE: Q>53_fQ4BOS <br /> TAX PARCEL I.D.M PROJECT.�DORESS: <br /> 1i133 �131:�� .AV?. <br /> DESCRIPTIONOF Connect dcain tn �,Y. <br /> PROPOSED WORK: <br /> Install drain linF, conm_cc d:�wn _Fout t _ catch b,�in in [he alley <br /> PERMIT CONDITIONS <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 Specifications. � <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424-5555 <br /> -'v. E3CF"'�� "'e[Y:�i �i�'L' yh3(1�i3C� �C3'.!lll7 �C�I1. � <br /> ° . ii?i5L_�t :• il'lE'�%. r/� <br /> 5. 'rut G�nsttuction siqn per MI�TCD standard on both side of the alley :9 houc _I <br /> ��ri�r to etactina work. /� <br /> , . !'n��.....UCt Fia1' ry}'c'tCh. .. . \�r <br /> O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> , <br /> ——--�� ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned ownedapplicant hereby agrees to hold and <br /> �=� �, save harnless the Ciry of Everett from any and all claims lor <br /> � damages,costs,expenses,or causes of aclion Ihat may arise <br /> �qpyov or nslruCli n , Da�o because ol inslallaliun and maintenance ol the improvement or <br /> // other right•of-way uso hereto applietl lor and funher agmes to <br /> . ���y�. �Z—�� "C� remove same upon notice Irom the City and to replace public <br /> ' FINAL INSPEC I N property dnmaged ihereby. <br /> Appmved as onslmcled Dalo .// i <br /> �L:.�f'" /�✓li�"'�...�/ <br /> Si atwc!olApplican Dato <br /> WORK AUTHORIZED�Y THIS PERAtIT MUST BE STARTED WITHIN 180�AYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS T08E DILIGENTLY PURSUED <br /> TO COh1PLET10N.THIS PEiiM1T MAV�E CANCELLED BV 7HE CI7V UPON ANV STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUFA710N. <br /> CPWP 1];U51 DATADAR,INC. <br />