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w .w, Da�c <br /> ����'M •yO��� PublicWorksPermit.t <br /> PERMIT BuiidingPermittl �/--- <br /> PUBLIC WORKS DEPARTL7ENT planning Relerence# <br /> 3200 Cedar Street <br /> Ee�erett.WA 98201 public Works Fee 5 <br /> �425)257-6810 .. . <br /> Guaranlee S <br /> �OWNER NAME APPLICANT NAME <br /> AND ADDfiESS: AIJD A�DfiESS: <br /> � <br /> PHONE: .:. �....:- r PHONE: <br /> TF%PARCEL I.D.p _ PROJECTADDRESS: _ , _ ,... <br /> D6SCRIPTION OP . . . .. <br /> PFOPOSED WORK: ' � - -� � � <br /> PERMII CONDITIONS I <br /> 1. All calls for inspection shall be made 24 hours in advance. <br /> 2. All work shall be pedormed in accordance with this permit and current City of Evcrell Design and Conslructipn <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 /> . � i� -< .4_�:.::� lt.�?:: .' �+ r=� „ �_i ` -:'_'� -'�- ,.- � : - <br /> � -'� -- <br /> _" .2=1. . _.." ' <br /> :,[ tiie nrr.tnzt , � <br /> � .•av�r<�;; mr,terial ':rrur: {i�un�i_ition, �i�iev3l�,: sr.�', dii�•�vn., shall b=e hs O <br /> •.L�� . _a. �:i _•L^.iC`^�� .`.�1fr.?. i`ip 4133�:ii1�3 !�i (:idCE!'i31 lU 311n••:�•� �li rt:-�� Y"i�lll�j'_: <br /> �� �Jlli Pl!�a� L��-{� v � �8kri1S Si• Y�E' 2C5:1�:E'i! Vri�: !'C!d �5.5Y. �\ <br /> bui i iin�7 imatr-ctals tr i[.e ;tank�-�i <,n coadw,} aroi « �et��ay �,�: i-�r kept r-1F,,. + <br /> �iq' ]�n.`ii'1'.l,y^ tt'rli'?i.� z <br /> ,.qO'J� [ d71�1 �?j�157�? CLII'��� C7'-72Tc'1' 31]tl :31•�E'1731)' dS (�-r f. ,': n= F + -C='tf; C+alliip.-' o <br /> >Y. 4 'tlJr ,-_!: tl:l.`: �?YCJ`'£3i�:� :C�:Ri-i7c 33 q�L. .,. . . . _ . _ . . - . .. <br /> . � _ -. ...�.� . . . ���1 . � i�r,-�Y.--n :�i� ,-i-,x�,..• <br /> �'^ <br /> V/ <br /> 0 <br /> � - IS - GS O. <br /> =f' �E�!�[ i!4� .__.--- <br /> i <br /> � <br /> � - � � � - � � -- �- - --i ACKNOWLEDGEt�1ENTOFCONDITIONS <br /> '� " �f J . The undersigned awnedapplicant hereby agrees to hold antl <br /> I.. G /�,` �/ // v7 save harmless the City ol Everett from any and all claims lor <br /> �f/� Gi� `� T / damages,r.osls,expenses,or causes of ar,tlon that may arisc <br /> I m o consim�c6o ''1 am because ol installation and maintenance ol the imnrovement or <br /> /�� ,�` � �D ('/ other righbol-way use heratu applied�or and further agrees lo <br /> c.,_..f [� %,� � � remove same upon nolice irom lhe Ciry and Io replace puUlic <br /> � FINAL INS � �ON property damagetl Ihef y. <br /> �i Approved Constmctetl Date �A`�J �� G /�� <br /> / � / <br /> /•�� <br /> I _ __ SignatureolApplicant D e <br /> CiOf7K AUTHOHIZED 6V THIS PERM19T MUST BE STARTED WITHIN 180 DAVS OF OATE PEfiMIT IS ISSUED AND THEREAfTER IS TO BE DILIGENTLY PURSUED <br /> I i�CO�dPLGiION.THIS PER1.11T�dAY�F CANCELL[D E3Y THE CITY UPON ANV STOPPAGE OP WORK ON THI$PFOJECT OVER 90 DAVS DURATION. <br /> Di.IAE?AH,i11G <br /> . ..i i,-.N,I <br />