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PUBLIC VI�ORI(� <br />P�RN�IT <br />. <br />PU6LIC WOHKS DEPARTMENT <br />3200 Cedar S�reet <br />Everell. WA 98201 APR 1 7 <br />(425) 257-8 <br />_ ��`��`E IIU(� ---- <br />OlNN6R NAME�pi � �� ,�� _ i.� �; <br />AF:O ADDRESS - <br />DINA:.L 4%:n <br />2GtiB1U741? <br />PHONE- <br />>fi(14ii1 �li�9ilflFi��i <br />�nxrnaceu.o.a 1dcW Hi�[fSE - SASi� 163 <br />n�sc�i�nora or- <br />PPGPOSBD K'OPK� <br />PGRMIT CONDITIONS <br />APPLICANT N4ME <br />AND ADDRESS: <br />�an,� <br />PHONE <br />PROJECTADDRE55:� <br />lu�:.�.':ilfl, <br />� 31e <br />���oFi:;_�, �.� <br />Public Works Permit k i�� ri r, i��_;,,-i : <br />Building Permi� # <br />Planninc� Relerence � <br />Public Works Fee S <br />06 Guarameo 5 <br />:•�'.'.�". -c.—.. r,.. _ <br />' '._ • ' ;i <br />7. All cails lor inspection shall be made 24 liour; in advance - phone (d25) 257�E3310 <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Cons�ruction <br />Standards and Specitications. <br />?. (;all Location Underground Service 48 hrs. before you d:g. TOLL FREE NUMBER 1-800-424-5555 <br />4. �.onnavt �lde :ewc per C..-_.• iit..sn:iaed 'r's F,01, •ij�, r.:,�;. <br />ri- �_�IInE'Ci C9nftOF� tIUWi19j.�Oilt3 2O C}l:: r.�L31713i12 ::}�3iE'IR X�L_'VlC)=•;� 2CrY Tf113 �.nC. <br />_. IOStull EC1i01011 COI1tC41 1(I�dBUCE'D d:2 deteemined �]% C�1C' Yut?Iic 6oeka 1I79�7eC'OC. ��lC�l <br />..� �ilt fence, 3tc;w balas, s�.�ale„ i�c' �co�ion Y�ianl:�ts. (F.ic.l;, 9�5-339-'9(i3j <br />i � <br />,)� :�i`)l%. �lilF':/`'�/ <br />�p�ovetl lor Co Stmctio� Date <br />NAL INS CTION � � <br />Appwved as C�nslmcled Oaie <br />ACKNOWLEDGEMENT OF CONDITIONS <br />/Th�: undersigned owner/applicant hereby agrees !o hold and <br />�� j�� s2�. e harmless the C�iy of Evereit irom any and all claims for <br />da nages, costs, �:.penses, or causes of action that may arise <br />� L+e�ause �f inr',�'!alion and maintenance of �he improvemen� or <br />��L other rio'n :�way use hereto applied lor and furiher agrees to <br />' C' remov�• d;ne upon no�ice Imm the Cily and �o replace pubGc <br />prope �y ciar� ed �here . /� <br />� % ��/<f � lo , c- _ <br />—__ _' _ ". 1_ 5��- _ <br />Si�naWre ol Applicanf Da�e <br />t'JORK nU1'�iORIZF.O �a1' T��IS PEPPAIT �dUST oE START[D WITHIN 180 DAYS OF DAIL PEF�d1T IS ISSUEO AND iHEREAFTE�i IS 70 BE DII IGENTLV FURSUED <br />TO CG�APLETIGPI. �I�IS FGHIAI7 PdAV BE CANCGLLED BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS PFOJeCT OVER 90 DAYS DURA710N. <br />