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/,. <br /> PUBLIC WORKS Date <br /> Pu6licWorksPermit#- - <br /> PER M IT Building Permit# <br /> PUBLIC WORKS DEPARTMENT Planning Retorence N <br /> 3200 Cedar Slreet <br /> Everetl.WA 98201 Public Works Fee S � <br /> (425)257•8810 � <br /> Guarenlee S <br /> OWNERNAME _ APPLICANTNAME <br /> ANOADDRESS: - � � +; ; ' -� - ANDADDRESS:� :-;:�— �1a'--•; <br /> �.� . �. . .. _ ___ ., � -.._. . <br /> X PHONE: PHONE: � <br /> 7AXPARCELI.D.X , _. PRQIECTADDRE53: . <br /> DESCRIPTION OF . . _ ... . . . <br /> PROPOSFD WORK: � � � <br /> PERMIT CONDITIONS <br /> t. All calls(or inspection shall be made 24 hours in advance. <br /> 2. All work shall be peAormed in accordance with this permit and curren;City of Everetl Design and Construction <br /> Standards and Specifications. �� j <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FFEE NUMBER 1-800-424-5555 i(,i�i <br /> _ . i� <br /> ��/� <br /> ._.� ::i.: V/ <br /> �i�• ., M <br /> W <br /> O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> — ACKNOWLEDGEMENT OF CONDITIONS <br /> The undcrsigned ownor/applicant hereby agrees to hold and <br /> '/ " 3/ O b save hartnless ihe City ol Everetl Irom any and all claims lor <br /> �' ��'�`�-� � — damages,costs,expenses,or wuses ol aclion that may arise <br /> A rov r Construciion � ate because ol installation and mainlonanco ol lhe improvement or <br /> other right-ol-way uae herelo applied lor and luriher agrees lo <br /> - ,` J Z�b'"Q remove same upon notice Irom Ihe City and lo replace public <br /> FINALINSPE TI N p�aperty02mqQedlhereby. <br /> Approvetl as nstructatl Date _ _��—� 1 <br /> _ r— 's� / ,,�' - - -/ /_ � -p <br /> SignaNroolApplican Dale <br /> WORK AUTfiORIZED BY THIS PERMIT MUST B[STAR7ED WITHIN 180 DAYS OF�ATE PERMI7IS ISSUED AND T REAFfER IS TO DE DILIGENiLV PURSUED <br /> TO COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY S 1 OPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br /> EPWP PIW) D.�TABAR.INC. <br /> � <br />