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✓ <br /> PUBLIC WORKS PERMIT Date: 9/22/2009 <br /> Public Works Pertnit#: PW0909-021 <br /> City of Everett Public Works DepaRment <br /> r�� 3200 Cedar Street Buildinp Permit#; <br /> s Everett,WA 98201 Planninq Reference M: <br /> (425)257-8870 <br /> Public Works Fee $: $ 1,994.44 <br /> Other$: <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> POTALA VILLAGE LLC <br /> PO BOX 13261 <br /> EV 98201 <br /> PHONE: PHONE: <br /> TAX PARCEL ID N SITE ADORESS: i!E!3(1f241EfEER- 7 J/5 J/I P 1F C <br /> DESCRIPTION OF PROPOSE�WORK: <br /> POTALA VILLAGE <br /> pERMIT CONDITIONS <br /> 1. Ail calls for inspeclion shall be made 24 hours in advance. <br /> 2. All work shail be periormed in accordance with the permit and current City of Everett Design and Construction Standards <br /> and Spec�fications. <br /> 3. Call Location Underground Service 48 fvs be(ore you dig. TOLL FREE NUMBER 811 <br /> PER APPROVED PLANS DATED 9-22-09 <br /> rn .n ;;W <br /> �-,-.,_. ��: ;y, E,�, <br /> , _ -•, -� ,.� <br /> �']r- F=f_� - <br /> �� . -�� - U'1 <br /> _ ��`�: '-" � <br /> vJ r� ��, <br /> t-_: +i �'.O <br /> b9 �i� ����. <br /> N 1-� .J <br /> I <br /> � c <br /> �, �,O <br /> y '•Z7 y _� <br /> 4 � �1~ (J� ���/� <br /> ^`K+I VJ <br /> t��t1]S'�V-� <br /> i.�r,r,�iz� _ �O <br /> . �--c>�.� -. r�9 <br /> `-iI =a <br /> 1 <br /> .� �J- <br /> ACKNOWLEDGEME-NT OF CONDITIGNS <br /> The undersigned owner/applicant hereby agrees to hold and <br /> — save harmless the City o(Everett irom any and all claims tor <br /> damages,costs,exp>nses,or causes oi action that may arise <br /> " because of installation and maintenance of the improvement <br /> /�-�-�� or other right-of-way use hereto applied tor and turther agrees <br /> � � ` 1 ��/ �Z 2 � to remove eame upon notica from the Ciry and to replace <br /> Approred (oSConstruction Date public property damaged thereby. <br /> ` // � <br /> \� — C. ` L - � ��-^` � — I � <br /> FINAL INSPEd ION Date <br /> Approved as Constructed gignature of Applicant Uate <br /> WORK AUTHOkIZED BY THIS P[RMIT MUST O[STARTN WIl'Ii1N 180 DAYS OF DATE PERMIT IS 155UED AND T}IF��FAFTER i5 TO BE DILIGENTLY <br /> PURSUED TO COMPL[T10N. THIS PERMIT MAY BE CANCELLED BY'�E CRY UPON ANY STOPPAGE Of WORK ON Ti1'S PROIECT OVER 90 DAYS WRAIIUN. <br />