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� <br />PUB�ic woRKs <br />PERMIT <br />PUBLIC WORKS DEP�RTMENT <br />3200 Gedar Street <br />Evere�t. WA 98207 <br />(425) 257-8810 <br />OWN[R NAIdE_ _ ,_ <br />ANDA�DF65S^.��7G 1?C:`SFS i���� <br />1170%� MAk�'�_ _: <br />I.Lx.f:YS��ILLF .. <br />PHONE �i�QnS°"7�4: <br />7A% PARCELID.H <br />Date _._ __ .. . . <br />Publ:c Works Permit # : <br />Ouilding Permi� # <br />Planning Reference # <br />Public Works Fee 5 <br />Guaranlee 5 <br />APPLICANi NAME <br />ANDAODRESS: ;.,'?;p p;$�'- <br />�i _ . �i ri .:�.i'.:',:� L�i; <br />.._ � �f1V.:•:'.L.:L� <br />DESCRIPTIOkOF' _ . <br />PROPOSEDWORK�. i�.-1 �..�.: �j�,t�.,117� �'_{:r:,F•_, <br />�i <br />S%�'%- C/N`�iCi7S <br />FERMIT CONDITIONS <br />PHONE. _ <br />_r,ili�`_]5j'� <br />1. All calls for inspeclion shall te made 24 hours in advance � phone (425) 257-8670 <br />2. All work shall be performed in accordance with this permit and current City of Gverett Design and Construction <br />S�andards and Speci�ications. <br />3. Call Localion Urderground Service 48 hrs. be�ore ycu dig. TOLL FREE NUMBER 1-800-424-5555 <br />Tn nnnTiu� <br />v r��.+��� <br />m <br />C% � _ � <br />, F.L INSPECTIO � I <br />Appmced.uConsnue:�eA Dale <br />i �� - �. 5 '� [i <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner�applicant hereby agrees to hold and <br />save harmless ihe City of Everett lrom any and all claims for <br />damages, costs. expenses. or causes of action that may arise <br />because ol inslallation and mam(enance ol the improvement or <br />other righhobway use hereto applied lor and lurther agrees to <br />remove sarne upon notice from ihe Ciry and to replace public <br />pwperiy damaged �reby. <br />c-a.v�/�rz'f�-- -- 3Jj�o � <br />Si �alure of AOPI¢ant Date <br />IYORK AU7HON17ED [3V THIy pGRM1f1T �AUST �6 S1AHIED WITHIN tE0 DAYS OF DATE PEH�dIT IS ISSUED AND THEREAFTEH IS TO BE �ILIGENTLV PURSUED/ Y.. 1 <br />IO C014PLLTIpN. THIS PEfilAli �dAY [�E CANCELL[D 9V Tli[ GTV UPON ANV STOPPAGE OP WORK ON THIS PROJECT OVER 90 DAVS DURATION. I /�� <br />� <br />