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<br />PUBLIC WORKS
<br />PERMIT
<br />PUBLIC WORKS DEPARTMENT
<br />3200 Cedar Street
<br />Everett, WA 98201
<br />(425) 257�BB10
<br />�/��/o� Ne�� �w ne r
<br />Ol"iNERNA1dE . �/ Qy� SUf/� Dle � �
<br />nNUADDRESS � � �
<br />iPHONE: .. . _ . . _ .
<br />TA% PARCE� I.D.A
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<br />DGSCRIPTIONOF • , ... . ',�'i-" -
<br />PROPOSED WORK: '
<br />Dam
<br />Public Works Permit # . .
<br />Building Permit M :
<br />Planning Reference #
<br />Public Works Fes6�
<br />PHONE:
<br />PROJECTA�DfiESS:
<br />_.
<br />- . . _ _ . _ — _ - . _ _ / �'R � _ -
<br />PERMIT CONDITIONS C\ ���
<br />1. All calls lor inspeclion shall be made 24 hours in advance. �/
<br />2. All work shall be performed in accordance with this permil and current Ci o
<br />Stand-rds and Specilications.
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<br />5%i;i,; . -- -� .
<br />Everett Design and Construction
<br />3. Call Loca�ion Underground Service 48 hrs. before you dig. TOLL � E NUMBER 1•800-424-5555
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<br />ral oI the per�it.
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<br />���t'PVp�l: perm�tt:.. .�, �_.... �r.,7 •�f m0`ev+a1 ie tllnva,i ,-.n tlits Pnn I�..
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<br />�uildinp es�-�:�, �racked cn �ida� �
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<br />�;ust. ��9CC� - • � . � �'��.�va sldr.ualk �7Y.i�i
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<br />. 811 !.pU3E� �j:_r?:',:alS iilU any bcnkan OL' �jdC�_rv 3Cci :1:i.7t f�;_ D�F•: .
<br />=v� �ie�vevay from the ftnnt j.r•-���rty :in� out �o thF �treet pevin•:.
<br />oat�h t.a.-�n -�- per City �"andard Plan tAn:r :�ith a g�s teap �u.ar ��
<br />�� c=_quired for tke p9�3;im� Vices.
<br />spei�!�ler s•rsc-,,,, ;� caq�,u.za P<� .� . . ,,n- .. . -
<br />���•.nt= r�f NFI`•� .,�:,•,dam::. . .
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<br />ApprWedlorConslruction ato /
<br />FINAL INSPECTION
<br />Appmvetl a5 Constmcictl Dato
<br />ACKNOWLEDGEMENT OF CONDITIONS
<br />The undersigned ownedapplicant hereby agrces to hold and
<br />save harmless the Ciry ol Everelt Irom any and all daims lor
<br />damages, costs, ezpenses, or causes of action Ihat may arise
<br />because ol ins�alla�ion antl maiNenancc ol Ihe impmvement or
<br />other riqh4ol�way use hereto appiied lor and luriher agrees to
<br />remove same upon no�ice Imm tho City antl lu replace public
<br />propetly damaged the��by.
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<br />SgnalweolApplicant Dalc
<br />IVJRK AUiHORIZED I3V 7HI5 PERAIIT AfUST OE STARiED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND 7MEREAFfER IS T06E DILIGENTLY PURSUED
<br />70 COMPLETION. THIS PLRh11T A7dV f3E CANCELLED OV THE CITV UAON ANV STOPPAGE OF WORK ON 1HIS PROJECTOVER 90 DAYS DURATION.
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