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� <br /> PUBLIC WORKS Date <br /> ii�is���� ,, <br /> prost:-o_ , <br /> PublitWorksPermi�p 30r,;�-�-��,n <br /> PERMITa���d��gP��m�,� � <br /> PUB'.IC WORKS DEPAR76fENT Planning Relerence# <br /> 3200 Cedar Sireet =>� ,i,p <br /> EveretL W�98201 Public Works Fee 5 "' <br /> �azsi zs��aeio ,JAN 2 9 200o c;ua�amee s <br /> ^- •,n,�;TING _ <br /> OWNGF NAME �" ' ' ' " APCLICnNT NAML <br /> nNo noor�essl6�q ;�AI!E i A\r n��u nooRess. <br /> EVEkETT :in � 's�_(il <br /> aiiorae <br /> a2525215�i�7 arior;� <br /> 1nxr�nracE�io a -� _� - `- , rr�o�er,i noca�ss.�� - � .•.. -•• •"v� <br /> NEW DE'.'r.4:I�Ii r.ax.:.=E <br /> uescr+irtioN or <br /> PROPOS[DIVORK� <br /> PEfiMIT CONDITIONS <br /> t. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All work shall be performed in accordanco with�his permit and current City of EvereO Design and Cons�ruction <br /> Standards and Specificalions. <br /> 3. Call Location Underground Service 48 hrs.before you dig. TOLL FREE NUMBER 1•800-424-5555 , , 1 <br /> �i. t.B\':EB 91tjE• ��WC pipe 103L$Lldl unde[ (�C0�.103Qi� <Id1"a.}? T!� II,r�:,' ".I^.1.: � ,•C.•I2 W <br /> ��tnll�jdC�e. � <br /> � Connect 311 Y� 7fti�� .1�+.n::Fouts t-v thH SldF !4c � <br /> .. . ?-'a�., dc_.. .i; L.. .. .i._ . tci:' . . . . _ _:.n�- �.ii: _ . ,. . ...L . � �. _ '..�. � <br /> W <br /> O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and <br /> ��� ��� ��-Z� - D S save harmless the City of Everett Irom any and all claims lor <br /> Approved r onsttu u n Da�e damages,costs,eapenses,or causes ol action itiat may arise <br /> /r��- because ot installation ard maintenance ol lhe improvement or <br /> �'. j_ other ri�hFol-way use hereto applied fo•and turther agrees lo <br /> •f- ._ S� �'�".�f-<c �- Z��- C`' remove same upon no�ice from the Ci�y and to replace public <br /> RNAL INSPE N� property dy maged thereby. <br /> AUpmved as ConS�mcled Oale ; � <br /> � � i . 12 IG I IGS <br /> Signa ure ol ApFlicam Dale <br /> i <br /> � <br /> lVOl1i��.i�IITHORIZED�V THIS PFRId:T IAUST�E STAR7ED WITHIN 180 DAVS OF DATE PERM1IIT IS ISSUED AND THEREAPTEN IS TO DE DILIGENTLV PURSUED <br /> �O COIAI9 f710q I Iu5"FI7611i t.1AY E3E CAIJCELLFD EY TNF CIiY UPON ANY$TOPPAGE OF WORK ON THIS PROJFCT OV[R 90 D4VS DUFldIJN <br />