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,�,-._.. <br /> ; <br /> rt„a..� <br /> �ltO •.. � {�ubLCWorhaPeimci•A ^/�// <br /> ��� Date��1� � �� mn� ouoi . __41/iara7-��--- � <br /> C+J �p ApUlicatien For —_._______,_ <br /> Q PUBLiC W�RKS P�ERMIT `'"°"°`"°„"Ce <br /> ,a�,�F�� S— <br /> y�� Lvss/nnl.Fcc Pai� $ � <br /> � Calnnce C1un $ <br /> � H�o Print or l�ype Only <br /> �N �I <br /> ypG�O� <br /> Mx _ 'S T <br /> y C� Owner Ma��ing Atldress City 7_ip Phone <br /> OyyH � <br /> NC�C 7��iJC�I� <br /> Y iC <br /> 1�-Iv � " qpp�i`� �a����'n/l/ Idailin9 Address Cily ZiP Phone <br /> t�y� -{(��� �. c- ' � L r��_ <br /> �"��y Describe Proposed Work � �r' U�✓� `������L�S�L_C��d' - <br /> g`° <br /> � <br /> ��� <br /> �.� _ LtJ <br /> Prolect Address(il knownl _ � <br /> Attach four I�)�opies ol plans for proposed work- Draw to scale and note ihe lollowiny as apUlicable: �� <br /> • P'operty Lines P CeMerline of slreet � <br /> • Outline and dimensions ol all existing anJ • Indicate North <br /> propose0 structures on the lot • Show any proposed grading changes <br /> • E.Istin9 and proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW T iIS LINE O <br /> � ' PERMITCONDITIONS <br /> � � ' 1.All calls br inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> � 2.All work shall be pedormed in accordance with this permit and current City of Everelt Design and Construction <br /> � � � Slandardsand5pecilications. <br /> 's.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � _ <br /> i � ' /7 � <br /> � �� / ���191� /"� 'i'��t�ll//�'n�`� <br /> i � 1—� �I,��//���f� ~ <br /> � '�_ �� �a- 89 � <br /> �-- � � <br /> �� d <br /> I <br /> � '�1`' ACKNOWLEDGEMENT OF CONDITIONS ��, <br /> The undersigned owner/applican�hereby agrees'o hold and save herm- � <br /> — less the City of Everelt Irom any and oll claims br dama�es, costs, <br /> r_� expenses. or causes ol actiun ihat may arise bacause of installation <br /> and maiNen�nce of Ihe improvement or other right�oi�way use hereto <br /> applied lor and further agrees lo remove same upon notice irom the � <br /> Appr�ved(or Construction Date Cily and to repla;e pu6lic uroperty damaged ihareby. li <br /> FINAL WSPECTION �a1e Date <br /> Approved as Constructed Signature o�APPlicant <br /> WJRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everelt PUBI_IC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> � 3200CedarStreet eE pI�IGENTLY PURSUED TO COMPLETION. THIS PEFiMIT MA1' BE <br /> Everett.N!A 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF�VORK ON THIS <br /> Phone:259�8810 pROJECT OVER 90 DAl'S DURATION. <br /> i <br /> i <br /> II <br /> i ' <br />