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Pus�ic woRKs <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evcretl, WA 98201 <br />`'ZS,��-A��STING �N s 12005 <br />Date <br />Public Works Permit R <br />Building Permit N <br />Planning Ralerence N <br />Public Works Fee 5 <br />Guarantee S <br />OWNEFNAME SMITA R M/ SMITH R B/ SMIT$ ANDLADDR[SSME SPRINT PCS <br />ANDADDRESS: <br />1232 RUCY.ER AVE <br />EVERETT WA 98201 <br />PHONE: PHONE: Q256��8651 <br />TA%PARCEL I.D. N <br />7 <br />DESCRIPTIONOF •��,CCYR�1 POLE <br />PROPOSED WORK: <br />PERMiT CONDITIONS <br />ADDRESS: <br />/ <br />/ <br />1; l0/2004 � <br />P60901-011 <br />8�4�1-�ZQ <br />590.00 <br />1. All calls for inspection shall be made 24 hours in advance - pF�nne (425) 257-8810 <br />2. All work shall be performed in accordance with this permit and �urrent City of Everett Design and Consiruclion <br />Standards and Specifications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-024-5555 <br />9. Pcovide sediment inserts in exisitng catch basin�. Provide additional erosion <br />contcol at the dicection of the public vocks inspector. <br />5. Nu tracking of mud fi dirt onto the public right-of-Way. <br />6. Call 925-339-7903 for public worka inspectiona. <br />u:- �3- `i4 <br />i� <br />BUI�_� <br />S�iCri6 <br />y <br />OTNJt <br />F W/IiVI� <br />�';J;'i.NS? <br />'-nt pi <br />:i:41.L, <br />+v"iO:S <br />748.%5 <br />4��C <br />4010L". <br />50.�'�3 ��'1 <br />20.00 <br />20, (ii) <br />b'�F.�, o::. <br />F_,.�,�—. � <br />:� ��'G�' �'� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />� <br />'r^ <br />V/ <br />HQJ <br />Li <br />The undersigned owner/applicant hereby agrees to hold and <br />save harmless the City of Everett Irom any and all claims tor <br />damages, cosls, expenses, or causes of action that may anse <br />because of installation and mainlenance of the improvement or <br />other righ4of•way use hereto applied for ar�l further agrees to <br />remove same upon notice from the City antl b replace public <br />prop e by. <br />G.J/1.7�'�� Z Z. Q <br />SignaNre ol App' ant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENRY PURSUED <br />TO COMPLETION. THIS PERMIT MAV BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PHOJECT OVER 90 DAYS DURATION. <br />