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PUBLIC WORKS Date _ � <br /> PERMIT PublicWorksPermile : <br /> Builtling Permit q _ . . . <br /> PUBLIC WORKS DEPARTMENT Planning Reference R <br /> 3200 Cetlar Strcet <br /> Everetl,WA 98201 Public Works Fee S <br /> (425)257-8810 . . <br /> Guarantee$ <br /> OWNER NAME APPLICANT NAME <br /> ANDADDRESS: ��. ........ . . . . ANDADDRESS: <br /> _,. - • , hf4R 2 2 Z007 <br /> _ __- . � �� �e�riNG.....:.......................... <br /> PHONE: � - PHONE: <br /> TAX PARCEL I.D.+r PRQIECTADDRE55: <br /> DESCRIPTION OF <br /> PROPOSED WORK: .:... ... . ... .. :' , . <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 this permit and currenl City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-80�-4245555 W` <br /> r <br /> . . . . .. . . .. .. . ._.�. .. __:._.. . � � _ . .- . 'A <br /> � <br /> . . .. . . . . M/ <br /> . . W <br /> ,St' cl.'.- /^:.P�cc.•cl ��7 �OC�� f�i- Ci�y /Zfa.v�,(' � ri�SPtcfioi�. O <br /> �,: �FiL_� � <br /> Z <br /> � <br /> ~ <br /> � <br /> 0 <br /> a <br /> -- ACKNOWLEDGEMENT OF COND�TIONS <br /> The undersigned ownedapplicant hereby agreos to hold and <br /> . ,� ` :��,� / �CI C7 save harmless the City of Everett Imm any and all claims lor <br /> A �ov r Constmciion Date damages,cosis,ezpenses,or causes ol action ihat may arise <br /> because ol installalion and maintenance ol the improvement or <br /> �J p other nght-o�way use hereto applied for and further agrees to <br /> ��� � / /� remove same upon notice Irom the Cily and to replace public <br /> FINAL INSPEC N `p�;p�' ama9�ed�heleby. <br /> Approvetl as C Irucled Date \ //�`// �7 ._z�. _ — _ . . <br /> \ / /�,..+�_ � / �' G� �p <br /> SignatureolApplicanl Date <br /> WORK AUTHOR!ZED BY THIS PERMIT MUST BE STARTED WIIHIN 180 UAVS OF DATE PERMIT IS ISSUED AND THEREAFfER ISTO BE DILIGENILV PURSUED <br /> TO COMPLETION.THIS PERMIT MAV�E CANCELLED BV THE QTV UPON ANV STOPPAGE OF WOflK ON THIS PROJECT OVER 90 DAVS�URATION. <br /> [PWP piW� DATAB�R.INC. <br />