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9Htit <br />y 3 <br />{1 lin H VJ <br />y r <br />OH <br />� IM8 <br />C:. <br />H <br />[" y It <br />z <br />C [� <br />OC�gOq to <br />[+7 <br />EjoEn CA <br />DateA4�s <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pubes Wo, Pnmd. 6'S— /O/ <br />e,la Dear . rs�/, sooy — <br />Pubu, Wanks Fee <br />Total Fee S <br />Lose Am( Fee Paid S <br />halame Due S� <br />170 vt <br />e'yo'VIA dr Caen i/o a -e � • Z= Fes'.Q a/7 i Srd2 N 7.r.7 -e- 5 00 <br />Owner visiting Address City Zip Phone <br />FM <br />City <br />Describe Proposed Work T ,�o�.fMS.,✓'2 Ae {AHi w Lr/D ft-y' <br />Prulecl Address(if known) u_/ St S. cf' 6 efeA-e Yi 9,rc=20 -1 <br />Attach tour 14) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />FEPMI1 CONDITIONS <br />1. All calls for inspection shell be made 24 his, in advance - phone 259.8815. <br />� 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />_ <br />Standards and Specifications. <br />3. Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />-Me _ <br />IVale,�_1 <br />11•vrngt PUBLIC WORKS DEPARTMENT <br />eCoder Street <br />Everett, <br />ett. WA 98201 <br />Phone: 259.8815 <br />AL ANOWLEDGEM ENT OF CONDITIONS <br />Ar <br />CIO` <br />MA <br />W <br />0 <br />n <br />z <br />0 <br />Iass- <br />lan <br />Y / <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages. costs <br />expenses or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />li ,aG -' � <br />Iffighature of Appl ant ' v Date <br />WORK AUTF - OZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />