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1 <br />PUBLIC WORKS <br />PERMIT <br />OrPUBLIC WORK DEPARTMENT <br />3200 Cedar Street <br />Everett, VIA 98201 <br />(425) 257-8810 <br />OWNERNAME Glacier Northwent, IM, lr%rr <br />AND ADDRESS <br />F'O Sox 1730 <br />SEATTLE WA 98134 <br />PHONE 2067687612 <br />TAX PARCEL I.D.It <br />DESCRIPTION OF 67,000 cu yd fill <br />PROPOSED WORK: <br />PERMIT CONDITIONS <br />ArPrPe MT fA"tC— <br />AND ADDRESS. <br />PHONE: <br />Date 4/17/2003 <br />Public Works Permit p Pi10,J04-1121 <br />Building Permit It <br />Planning Reference If <br />Public Works Fee S $1, 705.25 <br />Guarantee $ <br />3505 28th PL NE <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 this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800424-5555 <br />04-22-03 12:32PM W <br />r �; I rrovec f2bin ��1%�D 3 � 0304021 r' <br />r OT14ER 200.00— Bm '—^ <br />OTHER 400.50, 8 P V / <br />PW/RVW 368.25 e�I1 <br />PW/INSP 736.50 W <br />TOTAL 1705.25 <br />CHEK 170 <br />A rY12482 <br />b-�D"GabefM.", 12-W-01 <br />FINAL INSPECTION <br />Approved as Constructed Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and <br />save harmless the City of Everett from any and all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because of installation and maintenance of the improvement or <br />other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public <br />property dama up lhp eby. <br />'►� � z2 03 <br />Signature of Applica Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br />TO COMPLETION, THIS PERMI' MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DU-ATION. <br />