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Pus�ic woRKs <br />PERMIT <br />PUDLIC WORKS DEPART1dENT <br />3200 Cedar Stroel <br />Everetl. VJA9B201 <br />�'��i���G T—,: e S �Q6 <br />OWNER NAR1[ <br />AN�qDDRESS�. r,-,•y i � :'}1z.i;i.F,S <br />:�lr. hl':_}.`:". ..:� <br />EV°.'kETT <br />PHONB: <br />d2525251d6 <br />TAR PARCEL I.D, p <br />APPLICAIJT NAIdE <br />ANUADDRESS: <br />wh 982�i1 <br />PHONE: <br />PROJECTA�DRCSS. <br />DESCRIPTIO40P - � � <br />PROPOSED WORK. o: D�—:tTf'..' -iti'Al'-� AC'G1TIi.`i <br />PEi+MIT CONDITIONS <br />Dato <br />- - �-0n9 <br />PublicWorksPcrmllR pW��=.pr-�t�� <br />'i4i�ll1-il:r[: <br />Building Permit a - � <br />Planning Relerence a <br />Public WorAs Fee 5 <br />ci:, in <br />Guarantce 5 <br />1. All calls lor inspeclion shall be made 24 hours in advance - phone (a25) 257-8810 <br />2. All work shall be perlonned in accordance with Itiis pennil and current City ol Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underc�round Service 48 hrs. belore you dig. TOLI FREE NUMBER 1•800•424-5555 <br />.�. 1�,.._�= n.i-�,_ �a:ai:�:�rial f:�i ::icl.:�:.�,.,,,� �in�i•=L `h�.: �,L,f,,:.;:_�� ���,�,:�I.n,-,i !:�_ ,._.,t l�r�.io�-. <br />:-]u^�bi:r.i... �i= ��-�r��,_r�:m�-nt C�i. <br />.. ��i'�._ ..�,I.r. �. _ . ���:�I l,u:��limi .i�i �. �ti.�,_I'. <br />�Sr: ���' _ �� � �a s <br />Appiw. arConstmcllqn Date <br />� ; � _, � Cl� �=� �z% C• <br />�, . <br />� FINAL INSP CTION , ' <br />Appwvetl as ConslNctetl _ Dale <br />, ..i,�li� I�; `i� ('it S . , .. <br />- . �� ,. . .-,r. . !.�,.. � <br />�/ � <br />��` -_ <br />ACKNOWLEDGEAIENT OF CONDITIONS <br />W <br />1-- <br />Vi <br />W <br />O <br />Z <br />O <br />� <br />O <br />a <br />The undersi�ned ownedapplicant hereby agrees b hold and <br />save harmless Ihc City ol EveicQ �rom any and all claims lor <br />damages, costs, expenses, or eauses ot aclion thal may arise <br />�;(,�r, because ol lnstallation and maintenance of the improvement or <br />1%t�� <� oiher right-ol�way use hemto applied lor and lurther agrees lo <br />remove same upon notice from the City and to replacr, p�bli� <br />pr,oPe j� damaged theteby. , <br />< <.--t � �'' - 3�- D 5 <br />Signature ol A�licant Date <br />WORK AUTHOfi12ED OV (HI5 P[RidIT IdUSTl1B STARTFD IVITHIN If10 DAYS Of DAT[ PEfiA11T I�S ISSUED AND THEREAFTER IS TO BE OIIIGENTLY PURSUED� <br />TO COIdPL[7101J. THIS PERf,9T 1.1AV OE C4tF[LLF.O OY THE CITY UPON ANY STOPPAGE OP WOfiK ON THIS PROJECT OVER 90 DAYS DURATION. �/ <br />t <br />