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�uB�ic woRKs <br />PERII�IT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />�azs� zs�-ea,o � . . . 3 0 <br />LAFELAND H9ME5 INC K' ��FRI:� {� E`:�:r __JUL <br />OWNER NAIdE YV L'VY. S4d <br />AND ADDRESS�A� �,���Tr$ <br />92535b77�i7 <br />PHONE: <br />I APPLICANT NAME <br />WA Us`J8 ANDADDRESS: <br />200:;1p(1�50�)5 <br />i�.a 1IE4� HOtrSE- BAST!' 13.1 <br />DESCRIPTION OF <br />PROPOSED WORN� <br />PERMIT CONDITIONS <br />PHONE: <br />ADDilESS: <br />ii/o4/2oos <br />Date pidpyll-011 <br />Public Works Permit # C0511-013 <br />Building Permit # <br />Planning Relerence # <br />Public Works Fee S <br />Guarantee 5 <br />$i5.00 <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with �his permit and current City of Everett Design and Consiruction <br />Slandards and Specifications. <br />y 3,�������Qc�iQr��ln���r�un���s� rvic�y hr3be�ore��ourdi�qj TO�L FR�E NUMBER 1-800-424-5555 <br />�i. Co�ne•_t rooitop .:Ic�wnsr,outa to th� cle�ainr�ge syst.em prc�,viiieci foL thia lot. <br />t�. II1.C3].1 9Cr,5'_��❑ p:Q1iCOL IfiEd:iUCEr: .9r7 determin�d by the YLLii11C COCi:$ Ti19�?�CL�iC 9UCIl <br />a:• silt fen_•e, stiau La�es, ��ayie� cc ecosion Y:Ian�:e[� <br />G�S <br />Consimctetl Date <br />-. <�.. <br />.. �.,ss,.z - <br />-� � <br />ACKNOWI.EDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and <br />save hannless the City o( Everett irom any and all claims for <br />damages, wsts, expenses, or causes of action that may arise <br />because ol installation and maintenance of the improvement or <br />other rigM�of-way use hereto applied for and'.nher agrees to <br />remove same upon n tice from ihe City and to -�place public <br />proper magedlh reby. <br />'� � <br />Signature ol Applican� at <br />WORK AU7HORIZED BV THIS PEFIIAIT IAUST BE STARTED WITHIN 180 OAVS OF DATE PFRMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br />70 COMPLETION. THIS PERMIT MAV BE CAN�FLLED BV THE CITY UPON ANY STOPPAGF OF WOFK ON THIS PROJECT OVER 90 DAVS DURATION. <br />/ <br />Z <br />O <br />H <br />O <br />a <br />