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� PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS GEPARTMENT <br />3200 Cedar Slreet <br />� Everelt. WA 9820t . _ _ _ <br />,�25��`���'t�ST1NG ��� � r = �� <br />OWNEP.NAME' ........:.....� ._„� <br />AND AC�FESSP�� ISI�}; . � -i �� <br />LANF. ST.:v"r: ;:' <br />� <br />r�iioNe. ',c :3E �( � � . <br />TAx PARCEL I.D. p �' � - � �� � � � <br />�i:.. <br />DFSCRIPi�ON OF <br />PnUPOSED VIORK'. <br />PERMIT CONDITIONS <br />-'. _ <br />APPLICAN7 NAME <br />AND.4DDRESS: <br />PHONE: <br />Date <br />Public Works Permit tl ` - � ' - - <br />Duilding PErmit il <br />Planninc� Reference # <br />Public Works Fee 5 - ` � ' <br />Guarantee 5 <br />PROJECTADDRESS�. •. ,. ,.. <br />7. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All worlc shall be per(ormed in accordance with ihis permit and current City of Everett Design and Constructicn <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />,., , , ,., , :,� . <br />. . .� . . . . . .. .,� . � .. � . <br />. ..� 't. .. -�i' , :� , .. i. . . . . . Ci:..,�n.. .. . .. .,i . _. �.il...� . . . <br />�:c. , ., �,„ ��_11C {fi,ckti 7� ;, <br />_ _ � - __•-•- �....__ _.. ._ <br />-'=� c:T+;xP�'h�r'�—'�4r" <br />;���� r�—'���'� <br /><< <br />: -, � <br />.�� � � / <br />� r/�.%,oi !- <br />. ' A6Pm�rf��C <br />` � <br />��� i <br />i�Fl(JAL INSPE <br />AU�wvrd �5' <br />��� <br />!%" <br />Date' <br />% � <br />—� i <br />�i� ��' ���'�. <br />D.ite <br />� <br />_ � x~ �- , <br />ACKNOWLEDGEMENT OF COMDITIONS <br />W <br />� <br />V/ <br />W <br />� <br />� <br />Z <br />O <br />� <br />O <br />a <br />The undersigned cwner/appiicam hereby agrees to hold and <br />save harmless ihe Ciry of Everett irom any and all claims Icr <br />damages, costs, expenses. or causes of aclion that may arise <br />because of installation and mainlenance of the impmvement or <br />other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the Ciry and to replace pu6lic <br />proparrydamaged there6y. <br />\ i <br />i <br />�.- �'t ....,.__ � —v �. . � � . <br />Signa;u�e of Applicanl— - D�te- r'-...�:-J..� <br />WOHK Al1THOFIZED RY THIS PERId�T dUST BE STAHTED WITHIN 780 DAYS OF DATE PER611T IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br />TO COAIPLETION. THIS PEFMIT A7l.Y EE CANCELLED BY TH[ CITV UPON ANV STOPPAGF OF WORK ON THIS PROJECT OVER S� DA'/S DURATION. <br />