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Date � .__ ._ , , _ � <br /> PUBLIC WORKS -,-�,-�� � <br /> PERMITPublicWorksPermi�M Eis0615-pq= <br /> Buildinq Permil N <br /> PUBLIC N'ORKS DEPARTMENT planning Reference u <br /> 3200 Cedar Street <br /> Everett,WA 98201 Public Warks Fee 5 <br /> (425)257-8810 :_F.0 i i <br /> Guaramee 5 <br /> OWNER NAME APPLICANT NAME <br /> ANDADDRESS: JUi❑ JO�F F.Uc�Cla!1�' ANDADDRESS�. ����p ,,r._�-r P.odcigu�� <br /> 1532 ma le stceut <br /> F �C'.'� FfiF!IP JCLCCC <br /> Evaeett '�"- � -- -- E`.'._e�tr , =.w - - <br /> PHONE' FHO4E: - . � . 1 <br /> TAR PARCEL ID.a PROJECT ADDRESS <br /> �-� 1 �.t o� � <br /> ?FS�PTION OF ' <br /> rao sED WORk_ ; <br /> i.i ;�� <br /> .-� ". <br /> i�in <br /> �'� � J <br /> '- •'�„I�1T �R.� n "_ ' . . _ 1❑ ti . ._11 _. . .�_ ' <br /> .��C�1 tl?ar ,.1 -�,. :bC1 � .n ' ;i • • •. <br /> , �,t�„�.�y.. - <br /> �;T�ERMIT COND�TIONS <br /> � �_� <br /> , :, � <br /> , �� <br /> !�t�d111 ca]Is for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All v(pjk shall be performed in acwrdance with Ihis permit and current City of Everett Design and Construction <br /> Starir�'�rds_and Specifications. <br /> 3. Call`�qcat4n Uyderground Service 48 hrs.bebre you dig. TOLL FREE NUMBER 1-800-424-5555 <br /> �, _L_ � <br /> , I�h t�` .cr�, . , � .h . _ � <br /> � .- - . ... . . . . . ... . __ .,.7 , - ' <br /> i.��.,: �{.1 ' . . . ' ❑ � . . - . <br /> ' _ �w <br /> �/ <br /> � <br /> O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> Q <br /> a <br /> / ACKNOWLEDGEMENT OF CONDITIONS <br /> - -_ i <br /> � —� �t � 1� z( �i The undersigned owneriapplicant hereby agrees to hold and <br /> ' b save harmless the City of Everett from any and all claims br <br /> t�ppmv o.Cons mcu Daie damages.costs,ezpenses,or causes ol action that may arise <br /> / because of installation and maintenance ol pie improvement or <br /> � � ��2 � other rigM-oFway use herelo applied for and further agrees to <br /> � rem9ve same upon notice Irom the City and to replace public <br /> FWIILINSP :TION ptoperty�iama9e�thereby. <br /> App:ovedas onsimcled Dute ' � `� <br /> �� �/ S " _ " �� Fi <br /> SignaN(e o App;icnnt Data <br /> i <br /> , ' i <br /> WORR AUTNORIZ[D DV iH15 P[fi�dlT fdUST�E STAHTED lVI7HIN 180 DAYS OF OA7E FERh1l71 ED AND THEREAFTER IS TO BE DILIGENTLv PURSUED <br /> 10 COf.1PLETION.THIS PEf�IdIT MAV E�[CANCELLED 8V TH[GTV UPON ANV S70PPAGL OP WORK ON 7HIS PROJECT OVER 9�DAVS DURATION. <br />