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PUBL.IC WORKS <br />pERMIT <br />PU�LIC WORKS DEPhRTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />�azs�2s��q��Tg�� pFL' 1 ff 2U <br />OWNER NAME <br />ANDADDRFSS' LAi�.LI.F?JC� H�.{•C� _TIi� <br />pi� i� Ei-,,� � �1ry5 <br />L(Y.l JILVLIIJ i1.�t `�8.���J <br />PHONE: 4 �5j5��'jf.i% <br />TA% PARCEL I.D. a <br />:;8091::0�)�i 91L <br />DESCRIPTION OF rr�a xavsE - E.a:;:. c t��: ��_ <br />raoroseo wor�k ' <br />PERMIT CONDITIONS <br />APPLICANT NAME <br />ANDADDRcSS'. <br />PHONE: <br />PROJECTADDR[SS: <br />Date <br />Public Works Permit q <br />Builtling Permit # <br />Planning Reference q <br />Public Works Fee 5 <br />Guarantee S <br />�;10/%OG5 <br />FGIn508-018 <br />C�is�;B-vlr, <br />;:5.OU <br />:,C,T : ::H<:F.T PLAT 12(��_,�i ; _�,:, <br />1. All calls for inspection �hall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be per(ormed in accordance with this permil and currenl City of Everelt Design and Construction <br />Standards and Specificalions. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />•. ne71„'%B lll� LeU1.dC�3 ;1tjeL1,9].{C Ii3il�1 3i tiW CpCR�C OT �1tE <br />C,. Cc�nnect r�,"fzop ilounspeuts tc� the dcaina9� syytero E�co;,,.:i•_ci i_i *hi:: lot -'i;�r�.= iI <br />�.R. (� aW COC�IEt <br />i:. L:�ta_1 �����sic.r: soeccol tne_�s�.i[-� e[ ri«..., _�f r�;� "r- <br />- t� , _r�tt .. ,n•9acd� foc small F�accel� <br />—U� <br />ACKNOWLEDGEMEN'.' OF CONDITIQNS <br />The undersignetl owner/applicant hereby agrees to hold and <br />save harmless lhe City ol Everetl imrn any and all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because o( inslallation and maintenance o( the improvamenl or <br />olher right�ol-way use hereto applietl lor antl turther agrr.es to <br />remove same upon irotice from Ihe Ci1y antl io replace public <br />prope[gWa, ma�ed ther�by, <br />i.�L � 1�. , _� �' �U.. US <br />Si�nawra ol Applicanl v�j Dale <br />WOFK AUThi0RI7EU [�Y THIS P�R1.11T MUST E3E STARiED V�ITFIIN 100 DAYS OF DATF PERMIT IS ISSUED AND THEREAFiER IS TO BE DILIGGNTLY PURSUED <br />TO COt�,1PL[TION. TH6 PEfiMI i!,fAV �E CANCELLED BY TH[ CI7Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OV[R 90 JAYS DURA710N. <br />/ <br />W <br />� <br />'�^ <br />Vi <br />� <br />O <br />Z <br />O <br />H <br />� <br />O <br />a <br />