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PUBLIC WQRKS Da�e <br /> Pu61ic Works Permi�# <br /> PE R IIA 1 T Builtling Pennit J1 <br /> PUBLIC WORKS DEPARTMENT Planning Reference# <br /> 3200 Cedar Street <br /> Everett,WA 98201 Public Works Fae 5 <br /> (425)257-8810 � <br /> Guarantee S <br /> OWNER NAME APPLICANT NAME <br /> ANDADDRESS: �� � ANDADDRESS: <br /> PHONE: PfiONE: <br /> TAX PARCELI.D.# PROJECTADOpESS: <br /> DESCRIPTION OF <br /> PROPOSED WORK: - � � - <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be macie 24 hours in advance. <br /> 2. All work shall be performed in acwrdance with ihis permit and current City o(Everett Design and Consiruction <br /> Standards and SpeciGcations. <br /> 3. Call Location Underyround Service 48 hrs. before you diq.'fOLL FREE NUMBER 1-800-424-5555 � <br /> � <br /> V+ <br /> � <br /> O <br /> ����1 <br /> Z <br /> ,�� <br /> o��`��� �a�'� � � <br /> C� '�� e���"`k � X�Sc � <br /> �� .������,,,�5 � a <br /> y� ��`� � <br /> ; � ACKNOWLEDGEMENT OF CONDITIONS <br /> ��. � " " The undersigned ownodapplicanl hereby agrees to hold and ' <br /> - -� �� Z 2Z l0 D'� save harmless ihe City of Everett Irom any and all claims lor <br /> Approved lor Constmc on D. e damages,costs,expenses,or causes of action ihat may arise <br /> � because of installation ard maintenence ol�ho improvement o� <br /> other righl-ol-way use hereto applied for and further agrees lo <br /> remove sama uppn notice Irom Ihe Ciry and to replace public li <br />� FINAL INSPECTION pfoperty dafqagBd IherGb . <br />� Approved as Consimcted Dato / - <br /> `_ :---;-�� ?/,�/�� <br /> __ _ SignaNteolApplicanl J 0ate <br /> 'NORK AUTHORIZED BY THIS PERMIT MUST�E STAR7ED WiTHIN 180 DAYS OF DATE PERA+IT IS ISSUEDAND THEREAFTEP IS TO BE DILIGENTLY PURSUED <br /> TJ COMPLETION.THIS PEFMI7 MAY�E CANCELLED BV THE CITY UPUN ANV S70PPAGE OP WORK ON THIS PROJECTOVER 90 DAYS DURATION. <br /> EPWP p:OG) <br /> — — D4TA9Afl.INC.. I <br />