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Date__�s���� PUUbc WorAs Yerml ' V C' � ZJ� <br /> T �tyec— <br /> Application For B�eg.Dem.• /'7l J <br /> PUBLIC WORKS PERMIT P�°,o,AFaaF�° S <br /> Leta Avc�Foe PeiG S <br /> Print or Type Only ea�a��eo�a ; 2000 <br /> J/��rl�`�5 �l Lv�/�C _ /7/o iooT/fPL St=. �dc4�7T 9�'20�/ 337- S�f�oS' <br /> Owner Mailing Address City Zip Phone <br /> s/�l�fC� <br /> Applicant Alailing Adtl,ess City Zip Phone <br /> Describe Proposed Work �Stt�!��C_7'��h Nc'Zcl �L'S'.�E�✓� <br /> i��3 W <br /> Project Addresa(il known) �►��' E�E�ioe2 L n/. � <br /> Attach four(4I coFies of plans foi proposed work- Draw to scale and note the lollowing as applicabl=: � <br /> • Property lines • Centerline oi street � <br /> • Outiine and dimensions of all existing and • �ndicate North <br /> proposed structures On the lot • Sliow any proposed g�atling changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW TH�S IINE O <br /> PE^tdlT CONDITIONS <br /> 7. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall ba perfo�med in accoidance with this permit and current City oi Everett Design and ConsVuclion <br /> Standarils and Specifications. <br /> 3. Call Location UnAerground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWIEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereUy agrees to hold and save harm- <br /> less the City of Everetl Irom any and all claims 'or damages, costs. <br /> �%�l-(�LlU �Pby"�=v �'/�cg( expenses. or causes ol action that may arise because ol installation <br /> and maintenanCe of �he improvemenl or o�her right-ol•way use hereto <br /> applied lor and luriher agrees b remove same upon notice from the <br /> Approve[�for Cons�ruCtion �a�e Cit nd to replace puUlicP/�operty damaged Ihereby. <br /> I ,_ ��'Ll� �� -��—�� Lt/ <br /> FfNAL INSPECTION py�e Z3 6 <br /> Approvetl as Constructed Si nature ol Applicant � Date <br /> everett PUBLIC WORKS DEPARTMENT ORK AUTHORIZED BY THIS P'cRMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,�VA 98201 BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Phone: 259-A815 CANCELLED BY THE CITY UPON nNY STOPPAGE OF INORK ON 7HIS <br /> PROJECT OVER 90 DAYS DURATICN. <br />