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P'UBLIC WORa(-.�� PERiVI1T Date 09/10/2010 <br /> „ � Pubhc Works Permit # P`dV1009-004 <br /> C ty cf Evere!t P�blic V�lorks Departmer.t <br /> � -� 3200 G26ar S;reet 0'+-2G�610(FRI� 15:55 Building P2fmi1 J�, <br /> ;� , , Evereth��`F1�. 9azo1 F,E6-1 G"� -� <br /> �'' �` P_f�d�ininq Reference# <br /> i425) 257-8810 CI <br /> f'EF'HIT i;o.lu0'�004 Public Works Fee 5 S 25 00 <br /> Other 5 <br /> �--�,I�(' :?_.n�---_ <br /> �qN NER NAME AND A�DRESS: Ti_ R',��C�If��NAME AND ADDRESS: <br /> ,I;N�APJCE ��REENS �"_Lri BRODV�'GU7JAMES <br /> 9031 111H PL W <br /> EVERETT WA 98204 <br /> PHON�: <br /> PHONE: 4254184742 <br /> TAX PARCEL ID# SITE ADDRESS: 90�5 11TH PL W <br /> DESCRIPTION OF PROPOSED WORK: - <br /> CONDG 4,1AILBOX STRUCTURE ' <br /> PERP:11T CONDITIONS <br /> 1 rl; caL's for insp=_ction shall be made 24 hours in advarce <br /> ? AI�work shall be performed �n accordance with ;ne oermd and current Crty of Ever�tl DFsign and Co^s;iuction Standards <br /> and Specdications. <br /> 3 C211 Locat�on Underground Serv�ce 48 hrs before you dig TOLL FREE NUMBER 811 -- �� <br /> � ; <br /> 111;ULBOXES APPROVED T(, �E LOCATED IN PUBLIC RIGHT-0E-4YAY I � <br /> � � <br /> � <br /> THE �'UBLIC `I.'ORKS INSPECTOR IS CUFF IJDJDl�1AIJ �ZS-33°��•10a � � <br /> � <br /> � <br /> � I <br /> � I <br /> � <br /> I � <br /> � f. <br /> � I <br /> ! w . <br /> ,�c�hr�o+r✓��u�Fr.itNro� co�vo�i �or:s <br /> Thc undersigned ownei/apphcant hemby agrees�o hold and <br /> ___ save harmless the City o�Fverelt Rom any and all claims for <br /> - darnages, costs, expenses, or causes of acticn Ihat may anse <br /> �� �/i because of installalion and maintenance o(the improvement <br /> �, .��� /� � �1 _ � or olher n ht-of-way use herelo applied for and `unher agrees <br /> �=-;�y�//`~!�` �- �Y- � to remove same upon no�ice from the City and to reptace <br /> ;\ppra ed for Construction Datc public pwperty damaged lhereby. <br /> ' �.�-��Q �/y/ <br /> _�___��� ' - � �� <br /> fa�fNSPECTION Date � <br /> Approved as Construcled SignaWre of Appl�cant Date <br /> l':ORK AUTFtORI�ED BY TNIS vERh+IT t•1UST 8[ STARTFD l'JITHIN I80 DAYS OF DATE PERh1Ii IS (SSUFD AND T!�EREAFTER IS TO BE DILIGENTLY <br /> FUHSUEC TO C��dPLfT10>:. Tti15 PERF11i F'�AY GE C.A�lCELI.FD [3Y 1NE CITY U�O�;AP:Y STOPPAGE OF`.YORK OFl THIS FRO][Ci OVFR 90 DAYS DURATIOF:. <br />