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PUBLIC WORKS Date - <br /> Public Works Permit# . <br /> PE R M I T Building Permi�p <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street Planning Releronce H <br /> Everett,WA 98201 Public Works Fee 5 � � <br /> (425)257-8810 � <br /> Guarantee$ <br /> OWNER NAME APPLICANT NAME <br /> AND ADDRESS ;,: �. r -_�n� -��� AND AOORESS: <br /> - � TC► PQSTING..sEP..`..3..Zoo� <br /> _. . _�.�,_ :. . <br /> PHONE: ..,��.�- � PHONE: <br /> TAXPARCELL�.N _ � PRQIECTADDRESS: nQ <br /> . _ . �. _ ' '_ _ rT <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 peAormed in accordance with this permit and current City of Everett Design and Conslruction <br /> Standards and Specilications. � <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-024-5555 ` <br /> , � �,, � � � r <br /> _ . _ _ . ... ....._ _ _ . � <br /> ..- � :ntcvi l4«-3'LLCd:7 �?aC City 9L EVa_�arr ;;.: �.. _ � �/� <br /> _ . ' ,- , ' V/ <br /> . . ... . . '_�I�CCi�I IhFA UY�E'3 IIF�O(1 COro(�ICY.30❑ Uf t�:� : . . ' .. <br /> -����OV3� �`.: L�It- t [I11t /� <br /> r. ii . '.�. 1-:.: ric.� 1^ t: . `19"'}: � .::Yn L?.-,-. . W <br /> .. . . . " . ". �" � ' -. . - - . . . � - . .. . . ' O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undorsignod ownar/applicant horeby agrees to hold and <br /> � / ZL; p� save harmless Ihe City ol Everetl irom any and all claims for <br /> damages,costs,expenses,or causes ol action that may anse <br /> provea ons�mc�ion � Daw because o�installation end mainlenance ol Ihe impmvement or <br /> � : <br /> c �7 other righl�ot-way uso here�o applietl for and IuAher egrees to <br /> c�..�-[/ - ` J z( C� r e same upon notice iro Ihe Ciry and to replace public <br /> INA INSPECT r0 damaged y. <br /> Approvetl es C �Iructetl Datn -�l � (�� ( <br /> �L ! 1 /`�%i� <br /> SigwWre ot Applicant Date <br /> WORK AUTHORIZED BY THIS PEFih11T A1UST BE STARTEfI YYI7HIN 1 BO DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTtY PURSUED <br /> TO COMPLETION.THIS PERMI7 MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS OURATION. <br /> f 1'1':P i�.nnl DAT�BAR.INC <br />