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Pue��c wo�Ks <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 90201 <br />I - (425) 257-8810 <br />LVIS <br />l� ���iL'�-�' <br />PHONE: L�ZS� J�~�/wA <br />TAXPARCELI.D.M <br />DESCRIPTION OF <br />PROPOSED WORK: <br />PERMIT CONDIT�ONS <br />� <br />Date <br />Public Works Permit x <br />Building Permit M <br />Planning Reference a <br />Public Works Fee S <br />Guarantee S <br />APPLICANT NAME <br />ANDADDRESS: C IC�'� <br />�f � iz.i 14If,r„�� <br />PHONE: , �L' � �,4- <br />PROJECTADDRESS: <br />:-?th ":her.t. M.,una <br />v.'r'�t�iro] <br />�r <br />FQii�.., _.�_ .; <br />.:��, I i � .c,:. <br />1. All calls lor inspection shall be made 24 hours in advance - phone (425) 257•8810 <br />2. All work shall be performed in accordance with Ihis permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555 <br />W <br />�n.�c,._,,-�.�,i.�e ;I�.:er•tioiL <br />r� <br />� <br />� <br />l. Aa l:�ec r.h�� a.r.pi:,•;�_cl p��in:i <I:�c=..,i c,-.1`�_U� 3IIiI tlr� pubiic: :x,tr:� <br />,�, �.i�: i�ti,j, <br />�o,��( � � 5 z 7 <br />Approved lor Construction Dale <br />FINAL INSPECTION <br />Approvetl as ConSiru[ted �ate <br />m <br />� <br />7 <br />Z <br />� <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hoid and <br />save harmless Ihe Ciy of Everetl from any and all claims for <br />damages, costs, expenses, or causes oi action that may arise <br />because of insta�lation and maintenance of the impmvement or <br />other right-of•way use horeto appiied for and tuMer agrees to <br />remove same upon notice Irom the City antl to repWce pub ic <br />prope damaged th �reby� _ � <br />,. ///) `p� 7 � <br />�^� pXX.t.- <br />$ignawre ol Applicant Dale <br />WORK AUTHORIZED BY THIS PCRMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AI:D THEREAFTER IS TO BE DILIGENTLY PURSUED <br />70 COMPL[TION. TMIS PERMIT MAV BE CANCEILED BY THE CIiV UPON ANY STOPPAGE OF WORK ON TMIS PROJECT OVER 90 DAYS DURATION. <br />