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c � Date <br /> P���IV �O��V PublicWork,PermitK , . � <br /> �E RlNI I T 8uiltlirg Permit" <br /> . PUBLIC WORKS DEPARTMENT I Planning Reterencu�� <br /> "- 3200 Cedar Street <br /> Everetl,WA9ffi07 ���blic Works Fee S <br /> (425)2 <br /> antee S <br /> OWNER NAIdE APPLICANT NAME I, <br /> P.ND�DOFESS: •-" i'; ,:�'-�� ; . .,. ANDAD�RESS: -..���� 7.�,.•. , <br /> ��:�03 15TLi Si' � � <br /> f'.I�.7iE7"I' =,� i:''i�: I <br /> PHONE �':�5�r��S, 1;1 PHONE: _. _°,;'" I <br /> ,___ i . r1G: <br /> TAXPARCELI.D.d PROJECTA�DFESS: <br /> O�i:t?R3:'Fni^nn ,c � ..,, I <br /> DESCRIPTION OF ' <br /> PROPOSEDVJORK: �`fl�'C1Ct. •.ld9I7 pdd �: d�ain : _ _ .. <br /> ..,, ...�T 3 ��v�i. _ . . . _ . . . ... .:. . . .. . . . . �. � . � -. '. <br /> . .. �Y Cd1P. � . . . . . _ . . .. _ _ .. . _ ___ � . . . . I, <br /> -. --_ �. .,,,�.. .-.I �, '�.. . <br /> PERMIT CONDITIONS <br /> i. All calls for inspection shall be made 7_d hours in acivance. <br /> 2. All work shall be per(ormed in accordance wlth Ihls pennd and current Clly of Everett Design and Conshuciion <br /> Standazd5 and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•800-424-5555 <br /> � <br /> . � . _ . . _ , . _ . . . _ . i.�_:ei� �':�.0 ,. . � � . , . . . � �. . Y� <br /> �.-,�....,_:;.. ,-.�.�,,:�,r, a_n«roI for ^�:�n�teu�,-ticn 3�^tit�i+:- . . . . . . <br /> _ W <br /> O <br /> � <br /> Z <br /> O <br /> F- <br /> � <br /> O <br /> a <br /> --- r' ACKNOWLEDGEMENT OF CONDITIONS <br />� I; _�;_ � . -,��� i f The undersigned ownedapplicant hereby agrees to hold and <br /> �--'i. . �; ,��, .' / �/ 7 save harmless ihe Ci�y of Evere�l from any and all claims for <br />� ��t—'� ' � �'`�! ��"� r".'` ��('� damages,costs,expenses,or causes ol action ihat may arise <br /> , Approved ,on;Imilion Dale � 6ecause of installalion and mamtenance of lhe im�rovement or <br /> / <br /> - � � other right�ol-way use hereto applied br and further agrees to <br /> � ��� remova same upon notice irom the Ciry and to replace public <br /> FlNAL INSaEC ,N' propedy damaged�hereby. <br /> Appmved as onslmqed Oate � � �� - -2_ <br /> � i� ' l_ ,l�.i.'.�' <br /> t/- .� , �'. ''. , f ._ .-- r .. . <br /> Sigcalur'v ol Applicanl Dalo <br /> TO COMPLET�ION.7�H SYPERMIEMAY�E CANC[LLED�Y 7HETCITY�UPON AN�ST�OP AGE OF WOFK ON�THIS PROJEC OVEF 90 DAY3i�UREATIpNPURSUED <br /> oaraoaa.ir�c <br /> [PWP I]/O61 <br />