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PUBLIC �I/ORKS Date °-
<br /> PublicWorksPermit# --���
<br /> P E R M I T Building Permit#
<br /> PUBLIC WORKS DEPARTMENT Planning Reference#
<br /> 3200 Cedar Street
<br /> Ev Everett,WA 98201 Public Works Fee$ -
<br /> (425) 257-8810
<br /> Guarantee$
<br /> OWNER NRME�"`.,:;��'_.':�, '- ' _ APPLICANT NAME
<br /> AND ADDFi�SS:�. � . __ � _ � � AND ADDRESS:
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<br /> PHONE ,�F���;!,u� PHONE:
<br /> TAX PARCEL I.D:;# _ : PROJECT ADDR�SSc - -, : -
<br /> DESCRIPTION Q'F:_ ` _ _
<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
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<br /> ACKNOWJe.��GEMENT��� I NS
<br /> , ��d �'
<br /> /��, The undersigned owc,�Y c� ag o hold and
<br /> ��li��Y � .J�/ C�� save harmless the City o�e'�#�f��y�all claims for
<br /> pproved for Construction �at damages, costs, expenses, or caus��s�act�'�n 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 property damag�. thereby.
<br /> Approved as Constructed Date , e.. � ���
<br /> '==����� Y-- �L— c'�>�
<br /> Signatyfe�Applicant Date
<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.
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