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OWNERNAME <br />ANDAODRESS; <br />PHONE: <br />TAX PARCEL I.O.a <br />DESCRIPTION OF <br />PfiOPOSED WCRK: <br />� <br />PER�diT CONDITIJNS <br />PtJ�LiC VI6/OREG� <br />�G��V��� <br />PUBLIC VJORKS DEPAHTMENT <br />3200 Cedar Street <br />L=vcrep, WA98201 <br />(425) 257-8810 <br />PHONE: <br />PROJECTADDRESS: <br />Date <br />Pu61ic Works Permit N <br />Bui�ding Permi� k <br />Planning Relerence ;� <br />Public Works Fee 5 <br />Guaranteo 5 <br />1. All calis for �nspection shall be made 24 hours in advance. <br />2. All work shall be performed in accoidance with ihis permit and current Cily of Everell Design and Construclion <br />S�anddrds and Speci(ications. <br />3. Cali Location Underground Seivice 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555 <br />. r-_ , � � r_ � „-. . _ „_, <br />-r �.� � '� r 1 :l�p. ,-. � _. F-rr r 1 �..:?qt-c.r. Lrr.�co-+_+�-�-a:� - <br />. . . . _. . .. ' i7rm-c��vr-Fn � " <br />. � 7�, ri�n c��-,'c��z�'c�i <br />.��„-+:T f��i �..- <br />- �C..____. _.... , �I..� <br />r� <br />�., �; <br />. � <br />Ji .n si, <br />'' w :n � �-- <br />.s� E» cn <br />L.1 A y+ !tll F-+ F+ V1 <br />' ¢+ v�5' NO r� .c r.� w c,-i <br />`''� ��1�v:ep�OUtoC�'�• <br />!_.1L�I�J�='OV V�O� �[Jl <br />as <br />Date <br />Data <br />%/-C�'C� <br />TQ P�STI�IG �' �`___., <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and <br />� save harmless �he City of Evemtt from any and all claims lor <br />— damages, cosis, expenses, or causes ol ac�ion that may arise <br />because of installalion and maintan.mce o! lhe improvement or <br />other right-of-way use hereto applied lor and fuAher agrees to <br />remove same upon notice Irom the Ci!y and to replace public <br />pr qerty ed thereby. <br />_ ��.'��---J `�/�/c�- <br />�ureolApplicant Da�e <br />WORK AUTHOR¢EO BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUEDAND 7HEREAFfER IS TO �E DIUG[N7LY PUFSU[D <br />TO C01.1PLETION. THIS PERAIIT �dAY BE CANCFLLED BV THE CITY UPON FNY STOPPAGE OF WORK ON THIS PROJECT OV[R pp pqy5 DURATION <br />