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PUBLIC VI/ORKS �"' ' ; J;�.'°`� 1 , <br /> , <br /> PublicWorksPermita PWU101—U�il <br /> PE R IVI I T Building Permit q <br /> PU�LIC WORKS DEPART'dENT Planning Re(;rence u <br /> 3200 Cedar Sircei ���� ���� <br /> Everefl,WA 98201 Public Works Fec 5 ' ;�v <br /> / (425)257-8810 U^ <br /> Guarontee 5 <br /> OVJNEfi NAME NPPLICANI NAME <br /> ANDADDRESS'. j1C(Vci)1C��t(1 .-.l1COIll �.iL�UUC' �NDADDRESS. j{RI�'L1C,]{1 �.11:�' .$U11(�6`CS <br /> 110 St n��y p�int F�d. �'nd 1�1. 1z915 192nd ave ne Sut "tn i <br /> Santa Ro�a CA WOi)DLPNILLE WA `_+807'' <br /> ' pHpryE PHONE: <br /> ( '707 ) 2;�4-4240 ( 425 )915-0950 <br /> raxrnrace�+.o a rHo�[crnooaess: LU512 7th ave :_r_ <br /> o�scrairnoN or <br /> Fr�oro;FovaoaK I�istall undergrouna �onr?��it frr�m pol�� t�� vault <br /> in:�.ail �.q�����n,.+.. :;�;(L:,f JG;�d^:F[;•�-al,l��fnu:�-�iey in�;�nu}�.1.J1�•p��ic tuE•r.:aYiog V.�-�c�vi V:,�ilt <br /> PERMIT CONDITIONS <br /> t. FlII calls for inspection shall be made 24 hours in adv2nce- phone (425) 257-8810 <br /> 2. All work shall be per(ormed in ar.cordance with iP�is permit and current City of Evcrett Desiyn and Construction <br /> Standards and Specifications. <br /> 3. Cail Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555 <br /> �1 . �"a11 Por Luc:��_a> fur water and s;idesewi�x s�-,.�ic�.�s witt��iu Lhe pi_�t�Lic huW.� <br /> °� . ]'a.-.1'r�gr, ��] i�1.771�� 1:.�1 011fjlTl�9]. C'nT�%i.li-lpl? . <br /> w <br /> ��r� :tUt i�l��rk MLtLI }r���; �{��tlriq ru175CCU�_CiGa. (/y <br /> v• <br /> W <br /> O <br /> '-)1 3:4i:' � � <br /> O10].G�,;' <br /> l _ 45,Gu Z <br /> _ . i. 4r a�:�' A <br /> . r�e� . .. �;.�n�.� <br /> � i � <br /> Y/ <br /> O <br /> � � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> + �1 I The underslc�ned owner'appilc:�nt hernby agrees lo hold and <br /> ��'f�.�-� .t��—�� s�vc harmless Ihe Ciry ot Everetl irom any and all daini�;lar <br /> ni,nnveU Inr Consbuctiun oate � damages,costs,ezpensr.s,or causes of action that may arre <br /> ffz,c��j�L L✓0��,� li,/� because of inst�llation and maiMonunce of Ihr,improvement�:r <br /> " other righbof-way use hereto applied lor and furiher aprees tn <br /> �C �.����J — removc same upon notice from thr. City ard to replacc puPJir <br /> AL INSPECTION prOpetly i. bcrrby. <br /> �PP«��etl as ConsVUC�cd Daln -� p / <br /> i �/—���' L`l <br /> �— ��' — �J � S�qnaWre o1 A ,nl D_ne , <br /> P.URK AUlHORIIEf)Pv �HIS PERh11T IdUSI [3C STAH7 f_D N'ITHIN Ifl0 OAYS OF�ATE P[Rt11T IS ISSUED AND THEREAFTER IS TO BE DI�IGMTI]"PURSU[D <br /> ip CDI.TLFiIOIJ TI IB PERI,llT I.!AV OC l'4NG[LL[U f3Y 1HF�'I1 V UPON!NY S10PPAGE OF 1'lOf7K ON THIS PROJ[C70VER 90 DAYS UURATION <br />