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i�. <br />:':r <br />� �•' �;r'a�r <br />IFHONE: <br />PQJ�LIC M/QF�KS <br />PERN�IT <br />PU�LIC WORKS DEPARTMENT <br />3200 Cedar Stree: <br />Evcrelt, WA 98201 <br />(425) 257-8810 <br />5._ ..:....., ..._ .....- <br />TAX PARCEL I.D.N <br />DESCRIP710N OF <br />PROPOSED WORK:� <br />FERMIT CONDITIONS <br />APPLICANT NAME <br />ANDAODRESS: <br />PHONE: <br />PRNECTADDRESS: <br />Datc <br />Public Warks Permit M�� �: <br />9miding F.rmit N <br />Planning Reference: <br />Public Works Fae 5 <br />Guarantee $ <br />�. All calls for inspection shall be made 24 hours in advance. <br />2 All work shall be perforr�ed in accordance with ihis permit and current Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Undergrodnd Ser �ce 48 hrs. before you dig. TOLL FREE NUI�ABER 1-fi00-424-5555 <br />:��, _. <br />_ r•fosYon c�'mtr_nl m;z��suce�s a� ci.r�armin:.d by rh <br />nr«., �-i:r.�w �,ai: ..ea1Fs, nt. �,�.,,.i;,n f _.�nir.,t<. <br />� nY:?� L:p.:.i:'. {,LL Et��-�o th �la 'ry�^L;r.<i .+�.-p �..�_. . <br />-cV= I.iS+ 3IlrX J�rl';� h� ?Q•>. � 1'LE�I� dl/���_T�7C'. '. <br />`�� PGSTING 3 � �- �' <br />� <br />� <br />Vd <br />W <br />� <br />� <br />� <br />� <br />P�� <br />V/ <br />O <br />a <br />--- ACKNOWLEDGEM[NT OF COIJDITIONS <br />� The undersigned ownerlapplican� hereby agrees to hold and <br />�/ L !7r✓ IG7 // �/� r�ve harmless Ihe Ciq� of Everett irom any and all claims (or <br />- i���l�*oy / r�� ,n damages. cos�s� expenses. or causes ot ar.tion that may arise <br />I p proved �or Consimaion ��o because ot installation and maintenance of Ihe imprcvement or <br />olher right-obway use hereto applied tor and further agrees to <br />, ����������� remove same upon notice Irom the City and to replace public <br />�' .F%�ltLINSPECTION pfop ydamagedt t26�j.� :'� <br />�� Apnroved as Conslmcted Date � �� ��� � � <br />---- � - Z� - o � ���'�' - (��:U,'E''� ;��� �' <br />Signalure ol Applicant Dale � / <br />1 <br />VJORK AUTHORIZED BV THIS PERMIT MUST BE STAR�ED WI7HIN 1d0 DAVS OF �A7E PERMIT IS ISSUED AND THEREAFTER IS TO BE UILICEN7LV PURSUED <br />t0 COMPLETION. THIS PEFMIT MAY BE CANCELLED BY THE CITY UPONANr STOPPAGE OF WOHK ON THIS PROJECT'1VER 90 DAVS DURATION. <br />. ':4P p:OGI D�ITABAR.It:G <br />