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PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />(425) 257-8810 APR 15 2007 <br />Tn pnOT1AIn <br />Date --- - <br />Public Works Permit # - - - - <br />Building Permit # - - <br />Planning Reference # <br />Public Works Fee S - - <br />Guarantee $ <br />OWNER NAME <br />" <br />APPL'IFiANT.NAM9.... <br />AND ADDRESS: - <br />- <br />AND ADDRESS: <br />PHONE: <br />PHONE: <br />TAX PARCEL I.D.# <br />PROJECTADDRESS <br />DESCRIPTION OF <br />- <br />PROPOSED WORK: <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hours in advance. <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 1-800.424.5555 <br />dj 9 s 6 <br />Ap rov for Cocstmclioo D e <br />NSPECTION <br />Approved as Constructed Date <br />3 -ztJ-06 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownertapplicant hereby agrees to hold and <br />save hamtless 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 blic <br />prope nydam ge heeby. , <br />p <br />Signature otApplicant Date <br />WORK <br />TO COMPLETION. AUTHORIZED <br />TH SYPERMIT PERMIT <br />MAY BE CANCELLED BYSTARTED <br />THE 180 DAYS OF DATE PERMIT IS ISSUED AND THEEAFTER IS TO BE <br />ANY STOPPAGE OF WORK ON THIS PROJEC OVER 0 DAYS DILIGENTLY <br />PURSUED <br />EPWP (eft) DATABAn, INC. <br />