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Date - <br /> PUBLIC WORKS PublicWorksPermit# . • <br /> PERM1 T Building Permit H <br /> PUBLIC WORKS DEPARTMENT Planning Re�erence p <br /> 3200 Cedar Street <br /> Everetl.WA 982`1 Public Works Fee§ - <br /> (425)257�8810 ' <br /> ri'�� � �- p�G ���µ�•����C�, Guarantee 5 <br /> OWNERNAME ' APPLICANTNAME <br /> ANDADDRESS � '� ' � . ' ANDADDRESS: - - , - � <br /> PHONE: . - - . PHONE: - <br /> TAX PARCEI I.D.M PRQIECTADDRESS: _ <br /> ' _' �'r.-'� c.t �... . <br /> �ESCRIPTION OF . <br /> PROPOSE�WOFK: --... . _.. . . . . _ _ ;,.... . <br /> PERMIT CONDITIONS <br /> 1. All calls for in>pection shall be made 24 hours in advance. <br /> 2. All work sh�!�be pedormed in accordance with Ihis permit and current Ciry ot Everett Design and Construction <br /> Standards and Specilications. � <br /> 3. Call Location Underyround Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424-5555 <br /> . .. . . .. . . . . _ . . <br /> � <br /> � . � . � . _ . _ .. . . , . _ . . ��/� <br /> ,:t; :._ :n. _ _ . _ . V/ <br /> i�a� �nstructe��l �y nc�- Putl�r W M <br /> W <br /> O <br /> � <br /> Z <br /> O <br /> H <br /> � <br /> O <br /> a <br /> - -- -- -- -- -- - <br /> - ACKNOWLEDGEMENT OF CONDITI No <br /> `�/ /7 The undersigned ownerlapplicant hereby agrees to hold and <br /> > y�� /�' 1 �+ save harmless the City ol Evemtt hom any and all claims lor <br /> !� .�C' �Y'����_ damages.wsis,ezpenses,or causes ol action that may arise <br /> ro�edro�i ConsbuF�inn Da because of installalion and maiNenance oi the improvement or <br /> � / / / <br /> / / / /^� / r J / other righ4ol-way use hereto applied lor and further agrees to <br /> ,_/ %�-"�-- �. , remove same upon notice Imm Ihe Ciry and to replace public <br /> t� <br /> -frwA� N pmpetly damaged�hereby. <br /> Approved as ' nsVucietl Dala .. . �� ' / <br /> i — � ._ . - ; i�.' �� ��[�� <br /> � Signature ol Applitanl Dale <br /> N'ORH AUTHORIZED BY THIS PERMI7 MUST�E S7ARTED WITHIN 180 DAVS OF DATE PERMIT IS ISSUED AND THEPEAFTEH IS TO BE DILIGENTLV PURSUED 3 / <br /> 10 C01dPLETION.THIS PEPMIT MAY�E CANC[LLED�V 1H[CITY UPON AIJV STOPPAGE OF WORK JN TMIS PROJECT OVER 90�AYS DURATION. '��/ <br /> ❑'IYP P�Ofil DRT�B�R.MG. <br />