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Dato <br /> PUBLIC WORKS Publu:WorksPormtla <br /> PE R M 1 T Buddmg Permit a <br /> PUBLIC WORKS DEPARTMENT Plenning Relerence x <br /> 3200 Cetlar Slreel <br /> Evare��,WA o9�8,2^01 �.� � „ 3 ..e07 puMic Works Fee 5 <br /> ��'f V U I 1 N G..V C,....•,......�........ Guarentee E <br /> . . ---- -------- -----�-- �-- - - ---- � --- <br /> OWNER NAME APPLICAN7 NAME <br /> ANDADDRE:SS ANDADDRESS <br /> PHONP . , , PHOPJE <br /> TnX PAHCEL I D I --- - - PRQIECT�DDRESS. �� <br /> (IESCRIPTION OF <br /> PROPOSED WORK�. <br /> PERMIT CONDITIONS <br /> 1. All calls for inspeclion shall be m2de 24 hours in advanco. <br /> 2 All work shall be pedormed in accorda�ce wilh Ihis pormit and current City ol Eoarett Design and Conslruclion <br /> Standards and Spocihcatlons. � <br /> L. Call Locahon Undorground Service 4B hrs. bclore you dig.TOLL FREE NUMBER 1-800-424•5555 ` <br /> r <br /> '�A <br /> V/ <br /> .� .. , nf ian�l�erarnn�i W� • . . . , � <br /> rif;' :i[3f1•13C�jg r:ii_ O <br /> -.t vith (i�:� F�I�iI�' � � � � ' <br /> �,N��iniuml of � '�v. �,rn�,-„-� , <br /> � , . . . . . .. . �., . . . .. . . . • . � ' � <br /> O <br /> � <br /> �5�� �5�� � <br /> F. l�ir�,,, O <br /> FA � a <br /> s O`';,�;��,., �, �°�� <br /> `'•,�.���.i� <br /> I ACKNOWLEDGEMENT OF CONDITIONS <br /> I � The untlereignetl ownei/epphcanl heroby nyrees�o hold and <br /> � `' / , � �-� s2ve hnrmless ihe City ol Everet��rom nny entl nll claims lor <br /> i - �:��f� (lS,i� ( �r�'� � � . I, <br /> � / , dnmages,cosls.eepenses,or causes ol action Ihat may ense <br /> Fn vre lur Conslrucuon Nr � becauso o�mslalla�ion entl mamtonante ol�he improvemant or <br /> , , i othei nghbo y use herelo ryppGed lor nnd lurlher pgreos lo <br /> � romove s e upon nolke Irc/n�he Ci ntl to replece public <br /> �_ ."- . , //•��`".-�-.�.:. . �_ .__ _ propert xged Iherob k <br /> ' {IN�I iH5PLC710N / / <br /> pppri��.��;�sConSt�ucleA Delo � <br /> ,. ,. ,� ,�<<.,�f , -. ,�� / � /G 0 <br /> � � � ,. <br />� . . . . . . . Sgnelura ol Rpplrant �. Uale <br /> WOfiN AUTHORIZEO OY THIS P[HMII MUS7 BE STARTLD\YIiMIN tH0 f�AvS Of UAif. PFRMIT IS ISSUED AND THEREAFTER I510 BE OIIIGENTIV PURSUED <br /> TO COMPLETION THIS FEFlMR��AV OE CANCELLEO BY THE CITY UPJN ANr S70PPAGG Of WOfiK ON T1115 PROJECT OVER 90 DAVS OURRTION <br /> M1�fl�R.IHC <br /> Erwr�i'oei <br />