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PUBLIC WORKS Date <br /> Public Works Permit# - � <br /> PER M 1 T Builtling Permit# <br /> PUBLIC WORKS DEPARTM1IENT Planning Relerence a <br /> 3200 Cedar Sireet <br /> Everetl,WA 98201 Public Works Fee S - . . .' <br /> (425)257-8810 <br /> Guaraniee 3 <br /> OWNERN�tdE . . •� :,:, tr�.t. pPPLICANTNAME . .� ` . . . <br /> ANDADDRESS: j, . _ , ANDADDRE55: _ � _' <br /> r,.'vCFi,t-- � . <br /> PHONE'. PHONE: <br /> iA%PARCEL ID.a PROJECT ADDR[SS. , . , , ,, �� �,..,�.� <br /> UESCRIPTION OF <br /> PROPOS[D WOflK: <br /> PERMIT CONDITIONS <br /> 1. All calls for 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 ConstrucCon <br /> Slandards and Specifications. <br /> 3. Call Loca�ion Undert�round Service 48 hrs.belore you dig. TOLL FREE NUMBER 1•BOD•424•5555 <br /> W <br /> H <br /> N <br /> m <br /> � <br /> C /�+ 'an LbCl.�l ��Cr� Cr7 � IJ��cILKe � ��.J � <br /> �.� � <br /> � ��s,o����Ks �w �:s r„41 � <br /> i � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � � �(�- - ,'1 , — The undersigned ownerapphcam hereby aqrees lo hold and <br /> �� -�����< <.;�f I �-'L' ' � �� � � � save harmless ihe Ciiy of Everetl irom any and all claims lor <br /> ��Appmved ror Consimcuon Daie damages,cosis,e.penses,or caus2s of action that may arise <br /> because al installation and maintenance ol Ihe impmvemenl or <br /> oUier righbol�way use hereio applied lor and further agrees to <br /> remove same upon notice Imm the City ar.d to replace public <br /> FINAL INSPECTION pmperry dama�ed Ihereby. <br /> Approvetl as Cons�m[Ietl Dale . . <br /> Si�nalurc ol Apptiwnt �� . Date� � <br /> lVOfiK AJTHORIZED�V iH15 PERM111i MUST�E START[D WITNIN 180 DAVS OF DATE PERIdIT IS ISSUED AND THEREAFiER IS TO BE OILIGENTLY PURSUED <br /> TO COIdPLETION.THIS PEFMIT AfAV BE CANC[LIE�BY TH[CITV UPON ANV STOPPAGE OF WpRK ON TH�S PRQIECT CNER 90 OAYS DURATION. <br />