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� <br /> / <br /> PUBLIC WORKS Date <br /> +iA� Public Works Permit q . � . . . <br /> � PE R M 1 T Building Permit# <br /> PUBLIC WORKS DEPARiA1ENT Planning Retc.ence# <br /> 3200 Cedar Stroet <br /> Evemtt,WA 98201 Public Works Fee 5 <br /> (425)257-BB10 ' <br /> Guarentee 5 <br /> OWNER NAMG APPLICANT NAME <br /> ANDADORESS: . _ „ ��;�::.,:, ANDADDRESS: . <br /> PHONE: � - y ,., PHONE: <br /> lA%PARGEL t.O.M PRQIECTADORESS: <br /> i.4,_'4 �'q� <br /> . . <br /> DESCRIPTION OF _ . . - . . <br /> PROPOSED WORK: . . . .. . . .. .. . _,. _ _ _ ._ . ._ _ _ . ._ . ., .__„ :_,_. . . - .. <br /> PERMIT CONDITIONS <br /> 1. All calis lor inspection shall be made 24 hours in advance. <br /> 2. All work shall be performed in accordance with tl�i;permd and current City of Everett Design and Construction <br /> Slandards and Speciticalions. <br /> 3. Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424-5555 W` <br /> r <br /> . �A <br /> . . V/ <br /> W <br /> O <br /> � <br /> t_. � <br /> O <br /> . . �,w <br /> _I <br /> O <br /> a <br /> — —/� ACKNOWLEDGEMENT OF CONDITIONS <br /> _�MY��Yl�`ai -�� � Tho undersigned owner/applicant hereby agrees lo hold and <br /> g �� � save harmless iho Ciry ol Everen from any and all claims lor <br /> damages,cosls,ezpenses,or causes ol action that may arise <br /> i�nove�t mr Cons�mcnon . Dam t because of installation and maiNenance ot Ihe impmvement or <br /> / � <br /> / / ` /C C � mher nght•ol-way use hereto applied lor antl funher agrees to <br /> .�. „ L�`� � � romovo same upon notice Irom tho Ciry and b replace public <br /> FINAL IN�N property damaged Ihereb . <br /> — Approvetl ns Constmctc0 Dato � � � � ��O / <br /> Sign�olAppwlicant ��_ D o b <br /> WORK AUTHORIZED BV 7HIS PGRh11T MUST�E STARTED WI7HIN 100 DAVS OF DATE PERh11T IS IS�UEO AND THE �EAfiER IS TO BE DILIGENTLY PURSUED � <br /> 10 COh�PLETION.THIS P[RMIT MAV BE CANCELLED�Y THE CITV UPON ANY STOPPAGE OF WOIiK ON THIS PROJECT OVER 90 DAYS DURATION. <br /> C{'l1'P 1:Orl Da1P0aP.ING <br />