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Pus�ic woRKs <br />PERMIT <br />PUBLIC W09KS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 <br />(425) 2.i7-B810 <br />)WNER NAME t.�. ' APP� <br />�NDADDRESS'. . I`. �'��:11'..1 12l]IS�';1 AND <br />�_'�i'.' �'�L11��:•1: <br />EV$kEiT iVA '��: i�: <br />PMONE: Q?S.:S .'ll _ �l'� <br />TA% PARCEL I.D. M <br />DESCRIPTIONOF �yl�j,n� i�17V��W._�j� <br />PROPOSED WORK'. <br />t 1Q <br />PERMIT CONDITIONS <br />PHONE: <br />�� 1 <br />Datc <br />Public Works Permit M <br />Building Pcrmit a <br />Plannin9 Reference k <br />Public Works Fee S <br />Guarantee S <br />.;j�l/�Oi�� '. <br />/ <br />Pwo�os-o.0 <br />1. All calls lor inspection shall be made 24 hours in advance • phone (425) 257•8810 <br />2. All work shall be pertormed in accordance with this permil and current Ciry ol Evereu Design and Construction <br />Standards and Specifications. <br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555 <br />4. 'lu .:auun w:f:l� r�t rlrt .=w_�y ��iLou i:> <br />.:ii' LCivew,sy .aprnn ra��. ' <br />in_". �._�-�i .,� }:���� �ity �'-�_nii9.�r�1 k�uS. TLr, entir�_ dtiveway apr�;n <br />��� r�t `;:� .:;�tt.h �rn:l th�� ;_out:ii h.ilveG) t.^, .t fii11 ilepth <br />� ���.l,a�-,._; � . <br />�:.r_,,�ir_: ._ �c�=�:'�, <br />ppp��� lar C s�mc�ion ` oae � <br />/!--�� b'-�'-d — <br />t <br />' FINAL INSPECTION <br />Approve4asConstmclea ���P <br />03-22-02 11:35AM <br />q 0203030 <br />N2IUE 25.00 <br />TO7AL 25.00 <br />A OM7199 <br />'q.0i� <br />J�- <br />,_,, W` <br />mu�.t b. = <br />N <br />� <br />• <br />Z <br />O <br />� <br />� <br />CASH 2� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicaN hereby agrees lo hold and <br />save harmless ihe Ciry of Evereu fwm any and aN claims br <br />damages, costs, ezpenses, or causes o� action that may arise <br />because ol installation and maintenance of the improvemenl or <br />olhcr right-ol-way use hereto applied for and fuhher agrees to <br />remove same upon notice from lhe Ciry antl to replace public <br />property damagetl lhereeby/. <br />���ur�c�. -�tu�-�--'..�c 3-�z-U y <br />SignaWreolApplicam ���e <br />�O COMPLETOION E MIBSrPERM T M YI BE CANC EI.LED BV�iHE CITV'UPON ANO STOPPAGE OF WORK ON 7NI5 PROJEC OVER 90 DAYS IDURATIONPUfiSUED <br />