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��� <br />��x <br />>Hti <br />r <br />� H <br />H '�7 <br />O :C O <br />� !A H <br />ts7 O � <br />H tl <br />OH <br />��g <br />�V n <br />Cy� <br />g�y <br />ot7vHi <br />��� <br />Z H fn <br />HOCn <br />oate jQ PQSTING 3-3r-93 <br />Hpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuCLc WaMs Porm�it • �/�,�L—! <br />eiao ��ri� � <br />vu�nc v�orxs Feo 5 <br />Total Feo <br />Less Ppo� Foo PeiO $ <br />Balanco �uo J <br />$P oi� Lo. 333ot F�r-sr W�N so.� �aoo (�,��z�� w��t �u�,. ��0�3 <br />Owner Mailing Address �, . C�q� Zip Phone <br />J�•ti �-�r�a-fL�yo.-� <br />�/0 3�s�,yB�-n °i ai�z.,��,�LS 2oos MIrJO(L ,a,�� �. 5��� i�` Jh. �ISioL 3Z3-4�i-��{ <br />Applicant Mailing Aduress City Zip Phone <br />Describe Proposed Work ��=�rn o�.1 S-1 2 �c�G� J T�--� Li PJ.-n P � �`ra� I�J ) T�� 2 <br />rJ c-yi PJ M P � J�r�.-� r� ��� j L. '. C�,J oP i ccZ TO �Ld^'i r'-� i�J� 1�"�'v�oJ � <br />Cl:t��' �.�1�o tl�..)rJ�:>'`-cev�-�+.� <br />/�b� <br />Prolecl Address (if known) <br />L <br />� <br />Atlach lour (4) copies of plans for proposed work - Draw to scale and note the following as 2pplicable: <br />�roperty Lines <br />itline and dimensions of all existing and <br />�posed structures on Ihe lot <br />• txisting and proposed utilities <br />• Centerline of _�reel <br />• Indicate North <br />• Show any proposed 9rading changes <br />• Show measurements <br />'�1 PERMIT CONDITIONS <br />7. All calls tor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormc., in accordance with ihis permi� and current City ot Evered Design and Construction <br />'�/ Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Ir ��5 �J� �✓�fJ!'D�ed /��a�S d�7�c� `-7-/S-iZ <br />� <br />5, ���'"� v�5 /'/0-� Co�`�-'� �uo,-� cv.-� ��nc��Oi� � <br />5-�i{��i2�-, � vl` /d/t-�.� <br />�A1��� PUBLIC WORKS DEPARTMENi <br />32G0 Cedar Street <br />Evere�t'NA 58201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONUITIONS <br />W <br />� <br />f� <br />� <br />Z <br />� <br />The undersigned owner/applicaot herehy agrees to hold and save harm- <br />less the City ol Everelt Irom any and all claims for damac�es, costs, <br />expenses. or causes ol action Ihat may arise 6ecause of installation <br />and mainlenance ol the improvemenl or other rightoFway use hereto <br />applied fo and further a9ree5 lo �emove same upon notice from ihe <br />City and tc�replace public property damaged thereby. <br />Gj _�l� c�-t. <br />gnalu ol Applica Date <br />ORK TH if BY THIS PERMIT MUST BE STARTED WIIHI�J <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH iS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BYTHE CITY UPON ANY STUPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />--vr� <br />