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PIDBLIC WORKS � Date �;'?;;,?p05 / <br />i <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceda� Strect <br />Everett, WA 98201 <br />(425) 257-6�70 <br />owNerratirne f;e:in Aldeir�� <br />ANDAC�DFESS: <br />1n127 [l:t Avenue W <br />EVERETT AA ?5_nq <br />Pi+oNr: 925355E �?� <br />TA% PI�RCEL I.D. a <br />DESCRIPTION OF <br />PROPOSED VJORK� <br />PERtd1T CGNUITIONS <br />1 <br />PHON[: <br />PROJECTA��RESS: <br />Public`NorksPermita FW�.,SU4-��9 <br />�uilding Permi� q <br />Planninq Relerence # <br />Public Works Fee 5 <br />Guarantec S <br />1. All cail� �or inspection shall be made 24 hours in advance - phone (425) 25i-8010 <br />2. All wr,rk shall be performed in accordance with this permil and current Cily of Everett Design and Consiruction <br />St�� �dards and Specifications. <br />�. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER t-800-424•5555 <br />525.00 <br />9. ��ontractor to meeY W1Y�1 C.�l� C'1tV in�pectoz tu discus� v:�ck pcior tu be9innina <br />_onstcurtion (call 3�9-i4ii4y. <br />5• 12" pipu shall be used - the matecaal shall meet city 3YdI1C13Cds for �_ove[ T� C c <br />�eyuicement�. <br />r�. All beddinn and barkfill :�hall be ceu�hed cack. ~ �-. x <br />c� --i c� .-s o <br />7. A C.B. may need to be in�tnllFd in cunju�tiun �ith ttiia piol�ct�`�csn�'.i �it.t�;th•r <br />(?U�JI1C '.hiCi:S 1115��=�L'pC/ � =� ._ o <br />� r <br />� <br />�. � i� <br />m <br />lor <br />� ., i.' <br />nnProvetl as construcletl <br />� ���^� <br />Oate <br />�".�—�l_'" -- -- <br />Date <br />� - ic%`UG, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />V/ <br />W <br />O <br />� <br />Z <br />O <br />V/ <br />� <br />a <br />Thr, undersi9ned ownedapplicant hereby agrees la hold and <br />save harmless the City of Everep (rom any and all claims br <br />damages, cosls, expenses, or causes of action that may arise <br />because ol installation and maintenance ol the improvement or <br />other righFol-way use hereto applied lor and luriher agrees to <br />remove same upon notice irom the City and to replace public <br />prop� damaged t b' ,/ <br />-r-/�i. - - ' /`��..f Y Z��S <br />SignaWreo�Appli I Daie <br />1YORK AUTHORIZED BV THIS PERtdll h1US7 BE STARTED WITHIN 180 �AYS OF DA7E PERh11T IS ISSUED AND THEREAFTER IS TO BE DI! IGENTLY PURSUED <br />TO COIdPLETION. 7H15 PERM1tIT h1AY BE CANCELLED FiY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />