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PUB�IC WORKS <br />PERMIT <br />PUGLIC WORKS D[PARTMENT <br />3200 Cedar Street <br />E°�`�"�A��TING <br />�nzs� pEC 15 2005 <br />OWNFR NAME nnv� i�t�nl:VL <br />AND�DDRESS: �S7S LANGEk <br />SETTTLE <br />rHone: -'�1b6249590 <br />TA%PARC[LI.D.a <br />nescaiPtioN or <br />rRaroseo wor�rc <br />P[RMIT CONDITIONS <br />Dale <br />Public VVorks Permit k <br />Buildirg Pcrmil a <br />Planning Reterence k <br />Public Works Fce 5 <br />Guaramee 5 <br />APPLICANTNAIdE �ppM� <br />ANDADDPESS: <br />4t7+ 98134 <br />PHUNE'. <br />SUPPLY <br />PROJIlC7ADD�ES3 ���� MCDOUGALL AVE <br />11/29/�009 <br />P410911-018 <br />rr�oaii-oi� <br />1. All calls for inspeclion shall be made 2A hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with this permit and currenl City ol Everell Design and ConslruUion <br />Standards and Specifications. <br />3. Call Location �nderground Service 4R hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555 <br />i�-dc-U`t 4:07�", <br />#t 0410019 <br />NUiLD 177'7.75 <br />SRCHG 4.SG <br />H ()412001 <br />:EWEF 7U.OG <br />WAT� 0381,00 <br />N 041101c <br />OTHE� :,O.GG <br />TiITAI 3�83.�5 <br />i� i)IW f'L� <br />sso . o^,,; c <br />. <br />W <br />H <br />� <br />W <br />O <br />� <br />Z <br />� <br />t� � <br />e-..i ��'r:. O:��J <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owncrlapplicant hereby agrees to hold and <br />kive harmless the City ol Everett from any and all claims br <br />damages, costs, e.penses, or causes ot action that may arise <br />because ol installation and mainlenance ol the impmvemenl or <br />Mher right-obway use hereto applicd lor and lurther agrecs to <br />t ve sam �upon notice Irpm the City and to replace public <br />pmp n raged there6y / <br />vv ".� � — I j_ � � r� � <br />Si �e ol A IKanl Dale <br />l4'Of7K AUTMORIZ[D �V THIS PGRM19T �dUS7 OE STARTED \VITHIN 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTEFI IS TO BE DILIGENTLV PUP.SUED <br />70 COIdPLE110N THIS PERAIIT h1AY B[ CnNCELL[D E3Y iHB CITY UPON ANY STOPPAGL OF WORK ON THIS PROJECT OV�R 90 DAYS OURATION. <br />