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1. � <br /> Oate <br /> PUBLIC WORKS puaicWo�s�rm�N . <br /> PERMIT BuilCing Permit p <br /> PUBLIC WORKS DEPAFTMENT planning Reference N <br /> 3200 Cedar Streel <br /> Everetl,WA 98207 public Works Fee S <br /> (425)257�8810 � <br /> Gucrantee S <br /> OWNERNAME ..., „_,_ , . APPUCANTNAME <br /> ANOADORESS: '. .. . •�- . �� �� - ANDAODRESS: " " .-. . . <br /> PHONE: , ._ . . _ PHONE �. _ . L . ." <br /> TAX PARCEL I.O.N - -� � PRQIECTADDRESS: <br /> DESCRIPTIONOF � . <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 performed in accordance with this permit and wrrent Ciry of Everett Design and Construdion <br /> Standards and Specitications. W <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500-4245555 � <br /> . . � <br /> N <br /> m <br /> O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> — --— ---- ACKNOWLEDGEMENT OF CONDITIONS <br /> / � The undersigned ownerlapplicant hereby agrees to hold and <br /> � ( �� �--. save harmless the City o1 Everetl irom any and all claims for <br /> / i � )�� �� `� .� /� � damages,costs,expenses.or causes of aclion thal may anse <br /> p,pp��e m Gons� �/ Date because of installation and mainfenance ol Ihe improvement or <br /> , f <br /> other righ4o4way use herato applied lor and ludher agraes to <br /> 1�� ,�/ � ... 4 —/ remove same upon notice Irom the City anA to replace public <br /> --i-' propeny damaged thereby. <br /> FI ALINSh3�� <br /> ApproveU/Conswcted Date ;�� � �� �O � <br /> i �� <br /> SignaNre ol Applicnnl ate <br /> TJO COMPLET�ION T�S PERM TEMAV BE CANCEILED BY�THE CITV�UPON AN�Y STOPPAGE OF WOFK ON THIS ROJEC UVER 90 D YS IDURATIpNPURSUEO <br /> Wi�B��.�NC. <br /> 1 PPIPi�f11i� <br />