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Pue�ic woRKs <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everen, WA 98201 <br />(425)257-8810 <br />OWNER NAME APPLICANT NAME <br />ANOADDRESS: - . � �� ANDADDFESS: <br />PHONE: <br />TAX PARCEL I.D.A' <br />DESCRIPTION OF <br />PROPOSED WOAK: � � . . . � . _ <br />PERMIT CONDITIONS <br />PHONE: <br />PRQIECTADDRESS: <br />Date <br />Public Works Permi� '� <br />Building Permit # <br />Planning Relerence # <br />Public Works Fee 5 <br />Guaranlee S <br />T� POSTING..nu��...y...�........:.�. <br />1. i,�i calls for inspection shall be made 24 hours in advance. <br />2. All ,vork shall be performed in accordance with ihis pe;mit and current City of Everell Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 4:; hrs. before you dig. TOLL FREE NUMBER t-800-424-5555 <br />,v ,�.Cr.:...L� tLSiZF:iNi _ �,�� .t��t:L(;_IC'. ,__E..:=.Lii, ,=.2i�� L._.t.'vi;:Y: 59ALT _. ;: <br />.�aF:���btC�� Yz;FS'-7TFC. �.:�£. 11;. uriS7'7:i'" t,F ti`.7'F.`r:7AL 2S ..'�LfrirD (i!y ':F^; i7 -_';�� -. . <br />. ii=t;�j'� j.r.+r� s��,:f �'�5 '�:i L�gF.:i�.. ":` E.E �iT;z^;.�D �RITJ 2�'.Tw:;? � � - - � � <br />Jr- �c �r <br />. L`.�L:.=?1;:+ hll-.iLt;_hL.`i ��':� i- :�Tn.tiT�' :�7i SZDE::A.LYS:�ANL•���'�Lur'<'.nL?+.. �'.���EL. �[�7� f.'�_�-i'+.?� :. <br />- 'r0:: Yz:f��.t.STf?'.'A}i :!-T.Vt-L. � � . . � _ <br />;; <br />- �r:,- .�i., - <br />_.. ..i�J'; _ �._r�,'C;'... Ic `_'L1?? nT 9::r-.i^y-�?9(�4. %LLA`' �RLL fi??' ':rp-rrT� - =C,�"��.g�W <br />-�.�;��,a;� -,,- � <br />:, <br />��!lt��- �— �/7/-', <br />Ap ved br Conslmclion ate <br />Dato <br />T-zc- v <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and <br />save harm�ess ihe City ol Everetl irom any 2rd all claims lor <br />damages, cosls, expenses, or causes ol aainn Ihal may arise <br />because of inslallation and maintenanc�� c.' Ih�: improvement or <br />other right-ol-way use hereto applied ic:i and l��lher agrses to <br />remove same upon notice irom Ihe City and b r�p�;ce p�blic <br />property damaged thereby. <br />MCul�l�e �t4Jlk�; 3 �' ��-r <br />Siqnaluro ol Applicant Uatr <br />WORK AUTHORIZED �V THIS PERIdIT IdUST �E STARTE� WITHIN 180 OAYS OF DATE PERMIT IS ISSUEDAND THEREAFT�R IS T� HE DILIGENTLY PUPSUED <br />TO COMPLETION. THIS PERA7IT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WOPK ON THIS PROJEC7 OVEP 5G OAVS DUP.ATION. <br />EPWP (b06) DA�AEAF, INC. <br />W` <br />r <br />V/ <br />W <br />� <br />� <br />Z <br />O <br />� <br />O <br />a <br />