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PUB�ic w�RKs <br />PERMIT <br />PUBLIC WORKS DEPARTI,9ENT <br />3200 Cedar Sireel <br />Everett. �VA 98201 <br />,a25, zs T^o�n�TING MAY 0 7 <br />OWNGR IJNdf. APPLICANT NAIdE <br />nNDnODReSS�. 1121 124Tfi 7+VE N nND�DORESS. <br />BELLEVUE �1A 9E005 <br />425537�;:b7 <br />PHONE: <br />TA% PnRC[L I.D. a ��� <br />!dEW GhS <br />oesaarnowor <br />PNOPOSED YJORK <br />PERMIT CONDITIONS <br />PHONP <br />AUDRESS <br />Date <br />Public Works Permtl # <br />Buiiding Permit p <br />Planning Relerence a <br />Public Works Fee 5 <br />Guaraniee 5 <br />si::a��.�n5 <br />pWpSQS—�j?? � <br />GI)JUS—O6L <br />'_, 'c.d7 <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 permil and curren� City of Everet� Design and Construction <br />Standards and Specilicalions. <br />3. Call Location Underground Servlce 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555 <br />4. As pec 3F�GKJ\'eCI plar. �:lat�_d 4-1'1.-ii5 ami th-r public vc�eks inspectc�['s dieeeticn in <br />+he ii�_:�i. <br />O� <br />AVU�omd lo� consVucuon Y�air <br />�. , <br />� � ,� . � ; <br />� „ �,- I- `-� 1"; c-� ` -- <br />RNAL INSPECilO i <br />AfP�ovoO us Conshuc�etl ' Ddir <br />, .; � �;: <br />- +" . , �_. <br />.�>>� � ; , <br />-, s�-t <br />� <br />� <br />ACKNOWLEGGEMENT OF CONDITIONS <br />W` <br />r <br />V/ <br />W <br />O <br />Z <br />O <br />H <br />O <br />a <br />The unde�sgned ownerapplicant hereby agrees Io hold and <br />save harmless Ihe City ot Everclt Imm any and all claims lor <br />damages. cosls. expenses. or causes ot acUon Riat may ari<. �. <br />hecause ol installation and maintenance of U�e improvemc ��. . <br />athe ngM-of-way use h relq applied lor and lunhe� agrees to <br />remo sa e upon noti e om ie City and lo replace puoiic <br />prop y d �mag � ihe b�` �' <br />�::1 �' �� �,t-� _ �7 �L, ��� _ <br />ignature �Apphcdni Date <br />R'Uiih r1U u10H1; LC IiY I HiS PLIi6�ii h1US1 0[ STAfiiC � 11'ItHIN tB0 UAVS OP DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLV PU(iSUED y <br />7�� i:Oldl'LIJ ION 11nF Pf H611T !,!AY Lf CANCEI LEI) f3Y 71�[ Cllv UPON AHY S10PP�GE OF \YORK ON 7N15 FROJECT OVEF 90 DAYS DURATION_ - <br />