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Date1]_Ll_�183 P����":���5°��m"• �%_— <br /> em9o�o:.� �3/1'l6 6 __ <br /> Application For <br /> PUBL!'C WORKS PERMIT P°°`"'"°`"_`�� S zv � <br /> Tota F¢e <br /> Less P00��Fec Pmtl S <br /> ���_ <br /> Balance Due S <br /> Print or Type Or.ly �;'p 9,,' <br /> Duiardin D�r��lonment PO Box 5308 Everett 1VA 9820G 334 - SO18 _ <br /> Owner Mailing Address City Zip Phone <br /> �:!IfIC' <br /> Applicant Mailir.g Address Ciry Zip Phone <br /> Oc�•:ribeProposedWork sin,{�]_(� i�amil� T'es"P� — <br /> � <br /> •,as � <br /> ProlectAddress(ifknown) T �T 6 �-� inteTf� t-�' <br /> Attach four(4) copies of plans lor proposed work- Draw to::cale and note lhe folloH�ing as applicable: � <br /> • Prop=_rly Lines • Cenlerline of street � <br /> • Outline 2nd dimensions ot all existing and • Indicate North <br /> propeaed struclures on ihe lot • Show any proposed grading changes <br /> • Fxisting and proPosed utilities • Show measuremen�s � <br /> DO NOT WRITE 6EL06V THIS LINE � <br /> PERMITCONDITIONS <br /> 1. All calls for inspec�ion shall be made 24 hrs. in advance- phone 259•881 5. �\ <br /> 2. All work shall be perlormed in accordance with this permit and current City o( Everett Design emd Constraction �C' <br /> Standards and Specifica�ions. �- <br /> 3. Call Location UndergrounA Service 48 hrs. before you dig.TOLL FREE NU�IBER 1$a�0•424-5555. � � <br /> f <br /> 4. Per approved plans signed L2/7/83 and preliminary plat approval 6-79. � � <br /> � � � <br /> V/ ti . <br /> � . <br /> � , <br /> c ' <br /> � c <br /> r <br /> � <br /> G ' <br /> ACKNOWLEDC'_MENT OF CONDITIONS �� <br /> The undersipn^d owner/applicant hereby agrees to hold and save harm- - <br /> less the City of Everetl from any and all claims :or damages, costs, . <br /> ,�� expenses, or causes ol aclion that may arise because of ins!allation _ � <br /> ��� ��/ and maintenance of lhe improvement or other righ�-ol�way use hereto <br /> 7_��E,k��-y.,/lE;.-'L7z-- aPPlied lor and furiher agrees lo iemove same uPon n�tice Irom ihe = <br /> qpp ovnd f Construr, �on �' Jate Ciry and to replace publio property namaged thereby. <br /> �13 /� - � : J <br /> o ce ,�� ,�.�"�6 --� ' <br /> FINAL INSPE TION �� � � Da e - <br /> Approved as Constructed iy atu of Applicant <br /> 1VORINAU7HORIZED Y THIS PERMIT MUST BE STARTED WITHIN _ <br /> everet[ PUBLIG WGH�W�EP�RihiENT 180 DAYS OF DATE PENMIT IS ISSUED AND TNEREAFTER IS TO •� <br /> C� 3200 Cedar Sueet BE DILIGENTIY PURSUE� TO COh1PLETIOIJ THIS PERWiT MAY BL <br /> Everrn.�VA 3G201 CANCELLEG 6Y 1-fi[CITY UPGN ANY STOPPAGE OF�VORK ON ifll� <br /> P�wne�. 251�3815 PROJ[Gl OVER ti0 DAYS DURATIDiJ. <br /> � <br />