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a�/22�2�Q5 <br /> -` ����'� �0��� Date <br /> PW0509-t�33 <br /> P E��I T Public Works Permit# ? <br /> Building Permit# <br /> PUBLIC WORKS DEPARTMENT Planning Reference# <br /> 3200 Cedar Street '� <br /> � Everett,WA 98201 Public Works Fee$ ������ <br /> (425)257-8810 <br /> Guarantee$ <br /> OWNER NAME APPLICANT NAME <br /> AND ADDRESS: ���.Q FEDE�iL AND ADDRESS: <br /> E`'ERETT �� ���'�� <br /> 425��3�Q�'ll�. <br /> PHONE: PHONE: <br /> TAX PARCEL I.D.# ` '' " PROJECT ADDRESS: " °f • <br /> ROGKE�'iF IN R-i:�-1W <br /> DESCRIPTION OF <br /> PROPOSED WORK: <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hours in advance-phone (425) 257-8810 <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig. TOLL FREE NUMBER 1-800-424-5555 <br /> �.� � � � G�e�� � ��k �� 5��ew�( �C..� W <br /> � , r►� � �� ,� ,. . � <br /> � � _.. <br /> .. <br /> r...'...� e��:lh�"�'..I � <br /> -f- f �►���� ..; ,..., <br /> � ��� � �XC�'C� � � �r ....,�.�����_,�., ; �:.w.: <br /> �m�,,��.. .....�... ,��:,� m <br /> �'=' �;..''=;�� �`,t„� O <br /> _ . =�r,.: <br /> �r:�:. <br /> M,� ;.;;.�'�:�:; � <br /> ,-:;�:, : <br /> 4�' � Z <br /> ,,�:: <br /> „�� ::� <br /> ,�.'°��'',�� `� O <br /> �;;:� ::s<_ <br /> - tiF�i�n tf:F�k:":. .., � <br /> �.' ���»:]i+.� <br /> ,"��'an�n `v'~:' �... � <br /> '+��;:z•.� j....,z <br /> ' ....,, 'i.0 .....+F;;�. <br /> ....�..�t�«v.�.,..� O <br /> �. <br /> . � a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and <br /> save harmless the City of Everett from any and ail claims for <br /> Approved for Construction Date damages,costs,expenses,or causes of action that may arise <br /> because of installation and maintenance of the improvement or <br /> other right-of-way use hereto applied for and further agrees to <br /> remove same upon notice from the City and to replace public <br /> FINAL INSPECTION prope damaged there���� <br /> Approved as Constructed Date - � <br /> i. ,j <br /> Signature of icant D e <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br /> TO COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />