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PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar S�reet <br />Everett. WA 9820t <br />�azs� zs��o�Q:i'�'���+7 OCT 0 1 <br />)WYERNlWtfi'IR ^Tf7:�F'.Ft:ISES LLC APPLICANTIJAME <br />1ND ADDRESS�' AND ADDRESS: <br />i%Itij� J�IT1Y f}�� :iF <br />g�iTHELL �k 9FI:j'i <br />PHONE: Q>57Q?j7j:j <br />TA% PARCEL I.D.�y9 �;r�, ii.�,;,; > �(, E f;,j <br />D[SCHIPTIONO�'G� $.:��;t;E <br />PROPOSED WORK: <br />PERMIT CONDITIONS <br />PHONE: <br />Date <br />_, _,'::i�i�r <br />zWtinfl"j-1?iiy' <br />Public Works Permit # <br />rphn3-riq% <br />Building Permit # <br />Planning Reference # <br />$2c.i-( <br />Public Works Fee 5 <br />Guarantee $ <br />Pi�?IECTADDRFai9�� �,�j.?" ' <br />i. All calls (or inspeciion shall be made 24 hours in advance - phone (425) 257-8610 <br />2. All work shall be pertormed in accordance with ihis permit and current Ciry of Everetl Design and Consiruction <br />Standards and Speci(ications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />9. _r,nne�t -.i�1e :_ �_c i,ec r:t�• Star.i.scd �':. o�i?, c,i_, �%4- <br />:. Cc,nneot C�rn9LnF�`rlpL!ll'cF�OlIT3•L_i C}72 i�Cd7Jl.C�={�_ ::.d'3LE•ryi pL•_�•di.j>Cj iOL `fll� ].Cr. <br />t�. jf191:,i11 bCQSl�i❑ �7��IlCC�51 1f��,3FilCP3 .a� ij«:t�Cl�lll��� �i}' t�li_ ��i�i11C W�jCh.i 1119�iECt��r� 9:1�]'! <br />-,= silr :=.;;-•:.� c:rt,�, L��lu�, ��:;l�e, �,[ �eosi��n b?.,r.}:�ts. <br />��tor Can�� Ii� <br />i <br />,���� <br />NAL INS ECTION <br />Approved Cansimded <br />%�/� , <br />Dale <br />ACKNOWLEDGEt.�ENT OF CONDITIONS <br />� <br />Z <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and <br />save harmless the Ciry ol Everett irom any and all claims tor <br />damages, cosls, expenses. or causes of action ihat may arise <br />because ol installahon and maintenance of the improvement or <br />other right-of-way use hereto applied for and furiher agrees to <br />remove same upon notice irom the City and to replacr, public <br />proper�y damaged thereby. <br />, �—_�. ��.� 0 6 _ <br />SignaWre IApplicam Da�e <br />WORK AUTHORIZED BV 7HI5 PERMIT MUST BE STARTFD WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUE� <br />TO COIdPLETION. THIS PERMI7 MAY BE CANCELLED BV THE GTV UPON ANV � TOPPAGE OF WORK Or; THIS PROJECT OVER 90 DAYS DURATION. <br />