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�'UBLIC WORKS <br />PERMiT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Eveiett. WA 38201 <br />�a2sJ zs�-ae�o ?� ���� 0 ���7 ---MAY <br />B1.1'� T:IL=� CC�45�.!ICTSC,1! I2fC' <br />o�vrieF� wnr�neYo bCg: : u:: <br />AND ADDRES� WALL <br />206819791_ <br />PHONP <br />6:� 93Gi� <br />Tnxr�nr�ceuoa 1iEIl HOIIsE - =A1,IC 1�5i: <br />[7cSGHl�°TION Oh <br />P�70POSED NJORK <br />PERMIT CONDITIONS <br />!UiSi���lr5 , <br />Date <br />F'a;,� �i�i-i�u� <br />PublicWorksPermit# ''��Si�1-�)�:�3 <br />Building Permit rv <br />Planning Reference � <br />:.. .iiU <br />Public Works Fee � <br />8lfMtlntee S <br />PHONE: <br />[iii�i 8TH f�: M1' N;.f,T ' <br />PROJEC7ADDRESS: <br />_ ,.c.17:R;:<:: 'i�.ES':', �. . <br />t. All calls lor inspection shall be made 24 hours in adrance - phone (425) 257-8810 <br />2. All work shall be performed in acwrdance witli ihis permit and current City of Everett Design and Construction <br />`,andards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />4. Cunnerr .'.lde :.«=otet i.a[ C�r.� ;r;.miacd d's r;Ql., •;i�.:, '.�;ti. <br />6. CoI111ECt YCrUftOp !IUwI�3p���lVt3 LO the cie�aina.�e aystem pLo�.�lci2<1 fC�t ih13 li�T. <br />6. IIIF�tdll �1:OS1�?Il �:OI'.tC01 16�3:IUC9F 39 �jCrQCNllI@�j �i�( t�lr_ �+la�}11C WC•CF;:i 111in�CLOC� EUCil <br />ss �ilt fenc�a, ::tia�: Y�aies, �ti�,l��, oc =�os:on bianl:?t-�. iF:ick, ,925-33°-i903) <br />H> <br />ACKNOWLEDGEhv1ENT OF CONDITIONS <br />W` <br />r <br />tl/ <br />W <br />O <br />� <br />Z <br />O <br />_ / <br />� <br />� <br />The undersigned owneriapplicant hereGy agrees m hold and <br />save harmless ihe City of Everett irom any and all Gaims for <br />damages, cosis, expenses, or causes of action tha+ ��ay arise <br />because of installation and mainlenance of the improvement or <br />other ri9h�-ol-way use hereto applied lor and luriher agrees to <br />remove s�irye-vpon notice Irom ihe City and to repiace public <br />property da ged thereby. , <br />`' � l�i j�� /o -i � ::,,� <br />Signature ol Applicanl Dare <br />l".'OiiK AUThIOHl7[L` BV 7 HIS PGRP.117 P,1UST BF S7AFTEC SNITHIN 7�0 CAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS 70 BE DILIGENILV PURSUED <br />IO CO',1PLF fION. THIS PERMIT A1Av B[ CAf�CELL[D �� i�,? Cliv UPON ANY STOPP.IGE OF WORK ON THIS PROJECT OVEF 90 DAYS DURATi�!J. <br />