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P��"� �O��S Date <br /> Public Works Permit# <br /> PE R M 1 T � Building Permit# <br /> PUBLIC WORKS DEPARTMENT <br /> ���� � 3200 Cedar Street Planning Reference# <br /> Everett,WA 98201 Public Works Fee$ <br /> (425)257-8810 <br /> Guarantee$ <br /> OWNER NAME APPLICANT NAME <br /> AND ADDRESS: AND ADDRESS: <br /> --,r,,m- <br /> PHONE: PHONE: <br /> TAX PARCEL I.D.# PROJECTADDRESS: <br /> DESCRIPTION OF <br /> PROPOSED WORK: <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hours in advance. <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 W <br /> � <br /> � <br /> _ . .sv ._._�� �� it:iiC:i %t.��� L:.0 TLS•_"r:c•_2 � � <br /> C��s?dST4?UCTI��+N _TNaF'�''"T�3�:: ��1��2'� :4L�}d 42�,-3?�._?��:�3 �._• ��r � <br /> ,,�°y"`-�C;Y <br /> 4�/i":.i`'i O <br /> �:' �"� <br /> ��.J 'C_. <br /> .;9 1'�'1 <br /> � <br /> 5.�h9q p...� � <br /> �� 4 p l O <br /> l.$��•Y:f• . � <br /> r_� r.:.ti � <br /> r_;;�w�r» <br /> � u <br /> f_'.��� • .. . O <br /> C� :_� <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 all claims for <br /> '' t �t �� damages,costs,expenses,or causes of action that may arise <br /> A roved for Construction ate because of installation and maintenance of the improvement or <br /> other right-of-W,ay use hereto applied for and further agrees to <br /> remove s�m6�upon notice from the City and to replace public <br /> FIA prov dPas Co�nstructed Date prOp�r� aged thereby. � , <br /> ,;.�� /�� <br /> /!. _ / .�'�/� <br /> Signa re of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1 SO 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 /> EPWP(7/O6) DATABAR,MC. <br />