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:,:.: � <br />� �'=:��t,'3.�:: <br />� <br />..•'..�:��,:1� " . <br />ObVNER NAME <br />ANDADDRESS: <br />PHONE. <br />�����V ����� <br />P�i;IV��T <br />PUF3LIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA98201 <br />(425) 257-8810 <br />TAX PARCEL I,D.# <br />DESCRIPTION OF . . <br />PROPOSED WORY: � <br />PERMIT CONDITIGNS <br />APPLICANT NAME <br />ANDADDRESS: <br />PHONE: <br />PRQIECTADDf1ESS: <br />Da!e <br />Public N�orks Permd k <br />Building Permi� N <br />Planning Rolcrrncc :: <br />Pub6e Wor'.�, i ec� S <br />Guaramco E <br />' <br />� , 1 <br />1. All calls for inspeclion shall be made 24 hours in advance. � <br />2. All work shall be perlormed ir accordance with this permit and current City of Everett Design and Construction <br />Standards and Spacitications. <br />3. Call Localion Underground Service d8 hrs. belore you dig. TOLL FREE NUPABER 1-B00-424-5555 <br />fr..t��.i,. JtCa � h�iJl" <br />. ritt':1� L�_.rL.. <br />u4.]l� ��I��l. . <br />. ..... .. .... .. �� i . .. . i., , . w . . ..�,i . , <br />o�a=, a. art'� �p ..,.nn4r-r7T ..-� .. .�-. -. <br />� � <br />-� . <br />L': �,rllv .� �3 '�!' <br />I proved for Constmction Dat <br />as Constructed Dalo <br />%/`G %�—C�G�, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and <br />save harmless the City of Everett Irom any and all claims lor <br />damages, costs, expenses, or causes of action Ihat may arise <br />because of installation and maintenance ot tho improvement or <br />other righ4ol-way use hereto applied lor and fudher agrees to <br />remove ��ame upon notice trom ihe C�ty and to replace public <br />� propertydamaget}-ltfreliy. �� <br />/ 1 � (� �j� <br />�( l.-,`-G_G aLL� �j:ll� � ��—���_ <br />Signa�vrcolAppli� Dat I�¢ <br />(� l�� <br />��.70FKAUTHORIZEO 0Y THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF �ATE PEFMIT IS ISSUED ANO 7HEREAFTER IS TO P[ <br />f� � COIdPLETION. THIS PERMI71dAY BE CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON 7HIS PPOJECT Ov[R 90 DAY <br />i�.r'v+r Oi0G1 <br />ED <br />Dnrnnan, �r�C. <br />