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PUB�ic woRKs <br />PERMIT <br />PU�LIC WORNS DEPARTMENT <br />3200 Cetlar Strcct <br />Evcrett. WA 98201 <br />(425�257-8810 <br />301:i Ci�LBY .�VE <br />EVEF.ETT 6R <br />riione '1:;5�581tiii6 <br />TA%PARCELLD.� l� U� / lUJ <br />�ESCRIPTION OF 1i �' ��' � <br />PROPOS[D WORK�. <br />PERMIT CONDITIONS <br />Date 10/15i.:003 � <br />Public Works Permit N p{�0310-016 <br />�uildin�Pe�mita 8�-�10-025 <br />Planning RMerence q <br />Publit WorFs Fce 5 S p. 0 � <br />Guaraniec 5 <br />' ���� APPLICANTNAME P.�f(fL YTN : <br />AND ADDIiESS'. <br />982(11 <br />ri�oNe 4�567iti+91� <br />PfiOJECTAODRESS'. S��II? iLaLL ST <br />t. All calls lor inspeclion shall be made 24 hours in advance - phone (425) 257-8810 <br />2. t.11 work shall be perlormed in accordance with Ihis permit and cu« ent City ol Gverett Design and Co�struction <br />Standards and Specilications. <br />3. Call Location Underqround Service 48 hrs. 6elore you dig. TOLL FREE NUMBER 1-800•424-5555 <br />a. F,.�tmdat.ion [o t�e done pec dLaving stamF�ed try Chcis Cc,•;_ngt•_�n clated 10-',-!it. <br />5. II t�1B ClC}'' �V2C ❑NNij9 LO U.�? [�179 3CNd (pC IOUI11C1�?31 �iLLC�iO:iNSr t�lr_ pV�1NC Vlll �iE <br />ia�p:msible fu� iemoval i�f the facncle, <br />I�o ����1���1� �J <br />l_ 1'� J r��v � _-� <br />. 0 b 2003 <br />c, � ., a= ��; � "�; ;- <br />I'on,n! $rrv��es <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />� <br />0 <br />a <br />The undersic�ned ownedapplicant hereby agrees to hold and <br />save harmless ihe Ciry ol Evcrett Irom any and all claims for <br />damages, costs, expenses, or causes ol action ihal may anse <br />because ol installation antl maintenance ol the impmvemen� or <br />other righl-obway usc herCto applied for antl futlher agrees to <br />remove saine upon notir� Irom e Ciry and to mplace public <br />propeny damaged 1 r by. � <br />.,-,' � •�_ /,(I'- � a j <br />Signp;ure ol Appliwnt Uate <br />WORN AUiHORIYEU BV 7�H15 PERh11T MUST Pf. iIARTf:D 1VITHIN 190 DAVS OF DATE PEfiM1T IS ISSUED AND THEREAFTER IS TO B[ DILIGENTIY PURSUED <br />TO Cph1PLf3110N iHIS PLHA9T h7AV dE CANCEIlED f3V TFIE CITV UPON ANV STOPPAGE OF WORH ON THIS PROJ[CT OVER 90 DAYS DURATION. <br />