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&oonnl e1rz <br />PUBLIC WORKS PERMIT <br />City of Everett Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 <br />(425)257-8810 <br />OWNER NAME AND ADDRESS: <br />WELLS KYN E <br />UNKNOWN WA <br />Date: 1/7/2015 <br />Public Works Permit #: PW1501-008 <br />Buildinq Permit #; <br />Planninq Reference #: <br />Public Works Fee $: $ 25.00 <br />Other $: <br />APPLICANT NAME AND ADDRESS: <br />PHONE: PHONE: <br />TAX PARCEL ID # 00553631300600 1 SITE ADDRESS- 1521 VIRGINIA AVE <br />DESCRIPTION OF PROPOSED WORK: <br />STORMWATER CONNECTION <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hours in advance. <br />2. All work shall be performed in accordance with the permit and current City of Everett Design and Construction Standards <br />and Specifications. <br />3, Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 811 <br />(Fee = Misc Permit 525.-00) <br />v U` <br />JAN 0 8 2015 DD <br />CC!-Y 01 i VERf 'I C <br />I'etTn:t rvices <br />pal, a by CC <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and <br />save harmless the City of Everett from any and all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because of installation and maintenance of the improvement <br />or other right-of-way use hereto applied for and further agrees <br />TSC <br />� 5to removesame upon notice from the City and to replace <br />Appr s to Dale public property amaged th reby.INAL IN Date <br />Approved as Constructed Sign ure Applicant Date <br />WORK AUTHORIZED BY Tf+IS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT 1S ISSUED AND THEREAFTER IS TO BE DILIGENTLY <br />PURSUED TO COMPLETION. THIS PERMIT MAYBE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />