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PUBLIC WORKS PERMIT <br />Gty of EvereC Public Works Department <br />3200 Cedar Street <br />EvPretL WA 9R201 <br />(425�257-8810 <br />Date 09I09I2009 <br />Public Works Permit # PW0909•005 <br />Buildinq Permit #: <br />Planninq Reference # <br />Publlc Works Fec $ <br />Other $ <br />OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br />ADAMS-GODSALVE MELANIE <br />1827 98TH PL SW <br />EVERETT WA 98203 <br />PHONE: �[53559226 PHONE: <br />TAX PARCEL ID �7 00394900'01400 SITE ADDRESS: 1821 98TH PL SW <br />tON-0FPROPOSE� WORK: _ .. - � — -- ------ <br />WORK IN R-0 W FOR HOOK-UP'f0 MUKILTEO SEWER <br />.�ci: � • � ± : <br />$ OAO� °� <br />PERMIT CONDITIC�NS <br />1 All calls for mspechon shall be made 24 hours m advance <br />2 QII woik shall be perlormed in accordance wdh the permit and current City of [verett De��gn and Conslruction Slandards <br />and Specdications <br />3 Call Location Underground Sernce A8 hrs belore you dig TOLL FREE NUMBER 811 � <br />4 STREET RESTORATION TO BE CONSTRUCTED PER ATTACIiED STANDARDS #610 8 611 <br />YOUR INSPEJTOR IS CLIFF LINDMAN 475-339-7404 <br />> <br />r � �, <br />� � C <br />i . %: � •� „/= / <br />Approved tor Construction Date <br />_ _ - �/j.., � � �i. <br />fJNAt INSPECTION � Date <br />Annrnved as C.onstructed `1 - "• ! - � <br />� <br />E" <br />r <br />V. <br />0� <br />0 <br />�s <br />7_. <br />� <br />F <br />� <br />O <br />a <br />�CKNOWLEDG[tdEN�� Of CONDI110iV5 <br />1 he undersigned ownerlapphcant hereby agrees lo hold and <br />save harmless Ihe Cdy nl Eveietl frwn any and all claims lor <br />damages, costs. expenses. or tauses ol aclion Ihal may anse <br />ber.ause ol installaUon and mn�nlenance of Ihe improvemenl <br />or other right-ol-way use hereto applied foi and lurther agrees <br />to remove same upon imlice Irom Ihe Cdy and to ieploce <br />pubhc property damagec: thereby <br />� ' ' � , .� l � , o�,e�j7iR� <br />Siynature el Applicanl Date <br />\':UPN AUTHORICI D HY 1HI5 PI Rtdll P1U51 Uf S7ARTFD N:THIN Id0 DAVS OF DATE P[RMR IS ISSUED AND TNEREAFTER IS TO BC DIIIGENTLY <br />PUItSUI D� U CU��1PI I I1C7'+ I111'_• 14 F�41I ^1A1 HI UNCI Ll l U!3V 1 Hf CIlY UPON ANY S10PPAGE UF �^:GHN ON THIS PROIEC'T OVER 90 DAVS DURATION <br />