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AU�LIC 111�ORKS Date ,
<br /> � Public Works Permi�1f�'-��_ �� . . .
<br /> � PERMIT -
<br /> Building Permit# _ . .
<br /> � .w,. PUBLIC WORKS DEPARTMLNT � plannin,Reference#
<br /> 3200 Cedar Streel
<br /> EvereU,WA 98201 Public Works Fee S -
<br /> (425)257-8810� . _ � _ ._ .
<br /> �. Guarantee S
<br /> fOWPlEF NAME APPLICANT NAME,��
<br /> ANDADDfiESS . . � ANDAODFESS: -
<br /> ; `- . , . , P'�� 1 3 �007
<br /> . . , `-��'.`: �'� F��TINC� ,� ,
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<br /> I PHONE: � i.:,•j�.-'„ PHONE .
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<br /> 7A%PARCELI.D.N � PRQIECTADURESS�.
<br /> it;�,l_ ' _ _
<br /> DESCFIPTION OF � �
<br /> IPROPOSEDWONK: �.�i -��' ' � -- �, �. .
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<br /> PERMITCONDITIONS __ _ " _
<br /> 1. Atl calls lor inspeclion shall be made 24 hours in adv^ ice.
<br /> 2. All work shall 6e pertormed in accordance with this parmit and current Cily of Evaretl Design and Construction
<br /> Standards and Specifications.
<br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555 �(�
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<br /> -- ,aZ :�f tne pucnit.
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<br /> AGKNOWLEDGEMENT OF CONDITIONS
<br /> � ``, ,I�/� �1 Tho undersigned ownedappiicant hereby agrees to hold and
<br /> I l. / /1, //✓ �� �,/ save harmless Ihe C;ity ol Everett from any and ali claims for
<br /> 1�G' i- 'a t—�' 'b— damages,costs,expenses,or causes ot action�hat may arise
<br /> piav ConsbuCtion alc
<br /> (j because ol inst�llaticn and maintenance ol the improvement or
<br /> I�� � � !!!' �_ �/�7 other right-of-way us�hereto applied for and lutlher agrees to
<br /> I �----�'� ���L� / I remove same upon nolice from Ihe City and to replace puUlic
<br /> L.�'
<br /> INALINSPECT� prop�y llamaged�hureby.
<br /> I Appwved as Conslmcled Date \ _C_/1 p N � ���
<br /> �T�-� \�..L✓� fUI72�lL'S
<br /> . — — _ SignalurcolApplicant � Da1e
<br /> WORK AUTHORIZED BY THIS PERMIT NUST BE STARTED WITHIN 180 DAYS OF DATE PEFAIIT IS iSSUED AIJD THEREAFrER IS TO BE DILIGENTLV PURSUED
<br /> TO COh1PLETION THIS PERM1IIT MAY 8E CANCELLED BY 7HE CITY UPON ANV STOPPAG[OF INURK ON 7HIS PROJECT OVER 90 DAYS OURATION.
<br /> GPYJP I).OGI �ATAf3�R.INC.
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