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PUBLIC WORKS Date _ <br /> Public Works Permit# <br /> PER �_� ` `; `=_ = <br /> M'� 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: AND ADDRESS: <br /> ?R�_�r,vTt�l T,rI1•Jy tt�.F <br /> :`�1� H�YT Ai1E <br /> E��rERETT �,, :;:�-,�;1 <br /> PHONE: PHONE: <br /> TAX PARCEL I.D.# PROJECT ADDRESS: <br /> ._ _ -- -_ — <br /> DESCRIPTION OF ' " '" � � � `` ' <br /> PROPOSED WORK: _ --, 7 :; .. - . _ -" �r L <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 /> � <br /> : . _ _ - : '- . - __. _ _:-_ _. _ _ _ _ : - � <br /> ` . insr_aii clzi��ei,�ay ai�proach pec rir�, St_anciard� #3i,�7 ♦�� <br /> 6. Meet �aith Public �iorks ins��ector befc�re st.art.iny �.rork ` v, <br /> �;a. <br /> r-• i�, � <br /> i�`ari�' -:. <br /> _r: �- t::; O <br /> _ -i 1 ',.! � <br /> �_:.i ;::�:�,:: � � <br /> 4;i <br /> 1 <br /> �_._�.:- <br /> S7'� O <br /> P y � <br /> ��� <br /> tf:t A tF.F � � � <br /> r,:5 r,� <br /> a�n r05 �, <br /> rv "rm:r u O <br /> -. �r �; '_ <br /> �_ a. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Q The undersigned owner/applicant hereby agrees to hold and <br /> J �� ��� save harmless the City of Everett from any and all claims for <br /> App ved for Construction ate 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 /> �,ertlove same upon notice from the City and to replace public <br /> FINAL INSPECTION �perty damaged thereby. <br /> Approved as Constructed Date � /� � � ��` <br /> � ''���;�' /�,!7�,��" � ��/ � <br /> •� SignatGre of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE D�LIGENTLY 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 />