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��ug��c woRKs <br />��RMI'P <br />PUBLIC WORKS DEPARTMENT <br />32q0 CeAar Street <br />� Everett.�9��STING APR 1 7 2006 <br />� (4%5) <br />i,.�.�w n�r'�'w4�.��c- <br />owNEr� NnME 17032 35TA hVE :tE <br />ANDADORESS. <br />FOTHE.,i. ;7A <br />9"i�i9�1718 <br />i'HONE: <br />TAX PARCEL I.D. q � r�L � '' <br />1��J i's.;.:; - <br />DESCRIPiICN OF <br />PROi'OSED 1VORk: <br />PER�AIT CONDITIONS <br />: ;J..i <br />PHON[ <br />PROJFCTADDCF.SS- "- <br />Date �-., , `". . <br />-r �su-oie <br />Public Works Perm�t s! C'0511-011 <br />s�:iy�nq ae�•n�t a <br />Planniny Heleronce d <br />Public Works Fee S 5��' •`��� <br />Guarantee S <br />7. All calls for inspection shall be inade 24 hours in advance - phona ;425) 257-c310 <br />2. All work shall be performed in accordance with Ihis permit and cwrent City o( Everett Design and Consiruction <br />Slandards and S�ecifications. <br />3. Call Loca�ion Underground Snroice 48 hrs. before you dig. TJLL FREE NUMBER 1•800-424-5555 <br />. Citi:leCt :l:ie SE'.!dC �ir_C :ltj ;t3ndiCd�, r.'.I.if,:, ,rt��y, <br />. CpilllBQ2 COpfl��p ;fovn::JJOUi.': YU i.f18 (�C31q3rI2� "'+:LdI.^. '�. _�:/12._j T•.� �Yi13 �7C. <br />r, IO;Y311 .L'�al� il �_�.11*'.L'VL tii..:•:�iCEr7 _, i r I'..�:�r. � �- � ._ <br />��.. ,__. _ ... -�t ���.� _ � - vii�_ b�.�k� InSi:�rtnc ,urh <br />... . ..:i-- ' ..- . _. .. i�_�.,. _ .. <br />/� n <br />�r/��-�-/-.�- /�z� o <br />App oved br Consimeiion a�e <br />/ .S 3% � <br />FIN L INSPECTION � <br />Appmvetl as Con,irudetl Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicam hereby agrees to hold and <br />sive harmless the City of Everett irom any and all c'�ims for <br />damages, costs, eapenses, or causes of action that may arise <br />because of installation and maintenance of the improvement or <br />other ri9ht-o�-way use hereio applied for and furUier agrees to <br />remove same upon notice from the City and to replace public <br />pro�erry dama ed thereby. <br />t� "��OS <br />Signature I Appliwnl Dale <br />F1'ORF nU7HOivl7C� RV'IIiIS P[R�!IT 1.1UST E3E SLIRTED WITMH t80 DAYS OF DAiL PERMIT IS ISSUED AND THEHEAFTER IS TO BE DILIGENTLY PURSUED <br />TO CCfdPLH (iJN 7 HIS P[Rh9T 1,1A1' olf CANCELLED 6Y THE CITY UPON ANV STOPPAGE OF NJORK ON THIS PROJECT OVER 9U DAYS DURATION. <br />Z <br />Q <br />H <br />� <br />O <br />a <br />