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I j <br /> P�v�'V rMo��r7 Date <br /> PublicWorksPermi�N �'i.!i.i7`���.-�; '.,. <br /> P E R M 1 T Duilding Permit# <br /> PUBLIC WORKS DEPARTMENT Planning Reference# �� <br /> 3200 Cedar Street <br /> EverqlY,YNA 98201 . Pu61ic Works Fee 5 .� �.°� .��il � <br /> � <br /> ' Guarantee S <br /> �NNEIi NAME APPLICANT NAME I <br /> ANDADDRESS . _ -.: fn���li,;ll.�i�.;:.� AN�ADDRESS: . � pi:::.':].:� <br /> �r< 15th c�_. _ iStL .... . <br /> �,.. - -. tc-*t - -:r.: <br /> _ ..,r_t .. .. . _ _ .._ . <br /> PHONE: _•_r:-�-'y��i, PHONE: �� �._r.�cn�� <br /> IIAXPARCELI.D.N PROJECTADDRE55: <br /> ��' l�th "t <br /> IDESCRIPiION OP . . _ <br /> PROPOSEDWORK: ':�9`.'@ �1L?r1_!i -+.i�-.: ?.1'{ rnAY. ritrh b3r:'�^ �jC31❑ <br /> 1 <br /> . ... . _. . t'�-: . ... . ., . . .i .. I._.- . .'1.,':.� ?fi]}PCldl .��.nrr.d`_'� 3�-^ . _, <br /> � —'—_. _ . .. � 7= ._i� . ' . I� . ... . <br /> � <br /> PERMIT CONDITIONS ! <br /> 1. All calls for inspection shall be made 24 hours in advance. <br /> 2. All work shall be pertormed in accordance with this permit snd current City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. batore you dig.TOLL FREE S4UMBER 1-800-424-5555 <br /> .. _ . . . . . . ... _ �. . . . . <br /> � <br /> . . .. . . . . . ��/� <br /> V� <br /> W <br /> _ � <br /> � <br /> ^Z <br /> V <br /> ~ <br /> � <br /> 0 <br /> a <br /> � Ai:KNOWLEDGEMENT OF CONDITIONS <br /> � i � � �^.�-`` '� � The undersigned ownedapplicaN hereby agrees�o hold and <br /> � '�'L � � � . � '/ 1 . save harmless Ihe Cily ol Everett�rom any and all claims for <br /> L.....�_'__' ,�.+ Y �n j- � S._. . <br /> ' damayes,cosls,ezpenses,or causes of action that may arise <br /> i ' Appmv Cons�iucyan � Dat6 because ot installation and maintenance ol the improvement or <br /> � � olher right�obway use hereto applied lor and luhher agrees to <br /> i _ ' � Z � remove same upon nolice irom the City and to replace public <br /> i FINAL INSPECT N pmperty tlamaged lhereby. <br /> Appwved as Conslmcted Dale <br /> I ��. _ i <br /> � 'SlgnaWrAolApplicant Dalo <br /> VJOFK AUTHOflIZED BY THIS PEP�d�T h1UST BE STARTED WITHIN 180 DAYS OF DATF PEFMIT IS ISSUEDAND THEREAFfER IS TO BE�ILIGENTLY PUPSUED <br /> TO COMPLETION.THIS PERMIT MAV BE CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS PRCJECT OVEFl 90 DAYS DURATION. <br /> [NWP 1]i05) DATABAR.I:IG. <br />