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Pus��c woRKs <br />PERM�T <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />[vere�l. WA 982�'('1 ����lNC AP{2. 1 7 <br />(425) 257-8810 �' �` <br />BLUE FIDCE CGHSTF.[h_TIUN _T1lC <br />20b819791J <br />PHONE: <br />�809010020U800 <br />fAX ?ARCEL LD. # tiEW H! �USE EA <br />DESCFiIPT10N OF <br />PROPOSED WORK: <br />PERMIT CONDITIOfJS <br />APPLICANT NAME <br />W.� )�Blil`_+ ANDADDRESS: <br />10/5/20U5 <br />Date pW0510-003 <br />Public Works Permil # C0510-001 <br />Building Permit # <br />Planning Relerence # <br />Works Fee 5 <br />3uarantee $ <br />PHONE: <br />6i6 �iGT$ FL SLT NLuT � <br />PROJECTADDRESS: <br />c-r.ztr�rcc,n cF:�sT, Lc+r ti: <br />szs.ou <br />1. All calls for inspec�i�n shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be perlormed in acwrdance with this permit and current Ciry of Everetl Design and Cons�ruction <br />Standards and Specitications. <br />3. Call Location Underground Ser��ice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />�i. ('OIl1:NCt S1��P iP_VNC j?BC (.�lf}' :ii.:311rj.g.�r1 i!�i pli1� f�(��_� �:ilrf. <br />�i. COnT1BCL LOJfYnp .;]pWI18F�p11CC: i0 The di;inage syst�lti F�L'irVl•:lB•� IJC Cfll� Ii�C. <br />r'. 111Ef:i)1 rYO51f_�❑ CC�ntr�;l me:,;UC�i di �jEt@L'IR1t1B�j t�]% t�l@ F'UUL1�J S7vLF:i 1115(?GCTni�.t�1C�1 - <br />9S 311C ::�fiC'?� �YC�1�.' ti:i1BS� ::M."t12 . L. @C7::'_GiI A:371r.E'L.�.. 7�G,_"" ' � <br />iF.i�:;::, 9_. ,.,5-79(i;;l <br />� <br />.. if,� Cs 1[r lfF <br />�.�� :%• tsY ci1 � I�—� r—�. Jl <,�3 <br />� r) ._71.�. �./. - :: IG Jl <br />ACKNOWLEDGEMENT OF CONDITIGNS <br />The undersigned ownerlapplicant hereby agrees to hold and <br />save harmless the City of Everett irom any and all claims for <br />damages, costs, expenses, or causes o( action that may arise <br />because of installation and mainrenance of ihe improvement or <br />other right�o!�way use hereto applied for and turther agrees to <br />remove same pon notice irorti ihe City and to replace public <br />property am ed thereby. <br />� ��� �O%Tl�� <br />Signature of Applican� Da�e <br />WORK �UTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 BE DILIGENTLY PURSUED <br />TO COMPLETION. iHIS PERMIT MAV BE CANCELLED BV lHE CITV UPOM ANV STOPPAGE OF WORK ON THIS PaOJECT OVEN 90 DAVS DURATION. <br />W <br />� <br />� <br />W <br />O <br />� <br />O <br />H <br />N <br />a <br />