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PUBLIC WORKS Date �./�1CC. <br />Public Works Permit # <br />PERMITBuilding Permit # <br />PUBLIC WORKS DEPARTMEN t Planning Reference # <br />047r 3200 Cedar Street <br />Everett. WA 98201 Public Works Fee S -!T <br />(425) 257-8810 Guarantee S <br />OWNER NAME APPLICANT NAME <br />OWNERAND NAME <br />''� AND ADDRESS: ./CYam/ L'Jr" � f/I•`rC^/F <br />l;c O.'l Ca .2yvc <br />/llr,.k t'44A,/%ripe!) u,1 41'/d`/ <br />' S.ta-7f(e . <br />a7.;) wfsf ea.,..,cf�cre � <br />PHONE: Se 111, tdA 9'•j)/, j PHONE: <br />R .1 �a v ♦ r .n r•t: IKA f If. 1/'r . 14, i <br />TAX PARCEL I . M r•nujev' nuunraa: <br />DESCRIPTION OF Sc'j..4Q 0-( rjr;IL'!'f 04 4S:)rje.V•.Ik' u•-K SS;jjj tArjcln /•`•ff i•' '/.�t.i <br />PROPOSED WORK: f Pd V <br />fl, SE. 17r11U�t� W,11 G� e� rra�,crfy nt Tr c 0 <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 this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555 <br />L, iv1„or,�W fro f7 i G �Or�7 rc� L 11 t heeded <br />s f c?p�ace any oifon,ty�d 1/06 (E m� <br />7`/I;s wal-k <br />t4L� lJl /!/ -M <br />Appro onstruction D la �J <br />FINAL INSPE ION <br />Approved as nslrucled Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owneriapplicant hereby agrees to hold and <br />save harmless the City 0: 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 or <br />other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public <br />property damaged thereby. <br />n <br />��+NtAr' cG <br />Signatur Applicant ' DatT — <br />y/ <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br />TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />