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PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />EveretL WA98201 <br />1425) 257-BB10 <br />.....,...._..___. . _ . .. ,�' `. <br />_ _. ST�?T.. . _ <br />._ .... i�_Y'I� <br />FHONE: <br />. . _'S:'��C . <br />TAxPARCELI.Dd <br />I DESCflIPTIONOF <br />PFOPOSED WORIE <br />PERMIT CONDITIONS <br />APPLICANT NAME <br />ANDAODRESS'. <br />.. . "�'' PHONE: <br />PRQIECTA�DRE55: <br />Public Works Permii k <br />Builtling Permi� # <br />Planning Relerence A' <br />Public Works Fee 5 <br />Guaranlee S <br />1. All calls for inspection shall be made 24 hours in advance. <br />2. All work shall be performed in accordance wilh Ihis permit and �urrent Cily of Everelt Design and Consiruction <br />Standards and Specilicalions. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-024•5555 <br />. :,ns'.,i. _i.� ..:���n •��.,n � �,� ina<:.:iu�. : }�-,t . �ty •:�f .,���[�.tt ,,tarr.i.a�da. i n �mali p.iz�'ei�. <br />. Removo eco�ion cnnt.nl IOP_;13U[R3 up�,n com�letion �,g rll`��;�'7H'Y�,.��i'1,F`(��firy�^. <br />paoval cf the F,exmiY. �' c"'-�� ;-- ,_ ��� •. <br />E.� "'. r', i � <br />.?In �]1Li� mUQ� C�?C�'u pC �µr�L'�9 hq h? tC3CiC9�j onto C�l@ Cn3��W3`�.•, C' <br />. N�� buf idim_a materiali to be stacked un si�'�welks and the� sidev:,iks tv oe fie�1 ��,?!•�� <br />�ri �pon f�,r �,�de�ri:ian travel. ,�y �y <br />. Adiu�t watec metEi t�o:< 1" at�uVB 31�jB4:d1}: Grade. ('�] p; <br />.,. L�LL9C rnp`�nl 39 C���UlCwi by 119�iurf�?�� 's - <br />ra <br />. y� � <br />. . . . . . . �'� . en � e �ji <.�i <br />.- �.1.." <br />n <br />, - ZS-a j <br />ApOrovetl <br />W <br />� <br />� <br />N <br />�m <br />O <br />� <br />Z <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF COND{TIONS <br />The undersigned owner/applicanl hereby agrees lo hold and <br />save harmless ihe City ol Everett Irom any antl all claims lor <br />damages, costs, ezpenses, or causes of action �hat may arise <br />because ol installation and mainlenance of the impmvement or <br />other righl-obway use hereto applied lor and lurther agrees to <br />remove same upon notice iwm the City antl b replace public <br />p�qy damage �hereby. <br />�,,,��,� �. q j� fo� <br />Sir�na�ure ol Applicant Date <br />WORN AUTHORIZEO [3V THIS P[RMIT h1UST �E STARTEO WITMIN I80 DAVS OF �ATE PERMI7IS ISSUED AND THEREAFTER IS TO �E �ILIGENTLV PURSUED <br />TO COIdPLE1lON. TNIS PERMIT MAV �F CANCf:LI EO OV THE CITY UPON ANV STUPPAGE OF WORK ON THIS PflOJECT OVER 90 DAVS DUFATION. <br />LPWP P/OGI D4AB�F.INC. <br />