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�C <br /> Date �y �� PubLc Wmks Pe�mit< 35- 7/ <br /> . � Applicalion For eme.oeai.__ <br /> Pl1BLlC WOPKS PERMIT PuoTotalFecFee � <br /> LessAppl FeePaiE $ <br /> Print or Type Only <br /> eziz�ceo�e 5 ZL%OC) <br /> '�%�`� <br /> /�O?'L"Y -_ /// _..4,�!) a�S �. .Z'ni1�"va'. �7✓ L�[�CYC� ��o70Y __. . <br /> �Owner �t Mailing Address City Zip Phone <br /> 4c'.Y ,,��yy RJJr/ A'1� ���� a�✓C �57� G / .�, <br /> (�-� /Y. �ly� ) S",'_ �/L!"c7'� /l���h �7�' Or..� z <br /> �/ Applicant Mailing Address ity Zip Phone � <br /> � <br /> I, / n <br /> De• "`^��� Proposed Work K[i, ��( /�✓�'/s� �s^� � <br /> — .. �. <br /> � � <br /> — � H � <br /> N Z <br /> m <br /> 0 <br /> � co <br /> Project Address(if known) �s � �wi ��C� / 7�f� m o <br /> � --i c <br /> Attach four(4)copies of plans for proposed•��ork- Draw to scale and not=the tollowing as applicable: � o � <br /> • Proper�y Lines • Centeiline of s�reet /w �-I � <br /> • Outline and dimansions of all existing and e Indicate North v, m <br /> pwposed strudures on the lot • Show any proposed gr.ding changes .� � <br /> s Existing and proposed utilities • Show measurements � � _ <br /> DO NOT WRITE BELOW THIS LINE � � N <br /> < <br /> PERMIT CONDITIONS T <br /> o � <br /> 1. Ali calls for inspection shall be made 24 hrs. in advance- phone 259•$81 5. '� n <br /> 2. All work shall be perlormed in accordance with ihis permit and current City of Everetl Design and Conshuction � �r^ <br /> St�indards and Specifications. m � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•SOO•424-5555. � o N <br /> o r <br /> f� T2FES .L�.�-�L�NGNES Oi.C'T �m <br /> � i � lNEEOS .4N[� 07N1-•2 DE/3.�/S c w <br /> � � <br /> /'WUST �E �('E/+�C�EI� Fi�oi» Oti.l��vdGE �H.di✓,Qy'EL Uy � � <br /> • m <br /> f�iZc./�c'•G'T!/ � <br /> � � � <br /> x <br /> � n <br /> z <br /> � � <br /> � <br /> � <br /> � � <br /> -� <br /> n <br /> m <br /> ACIWOWLEDGEt.4E�.T OF CONDITIONS <br /> ��hr undersigned ownedapphcant hereby agrees to hold and save harm� <br /> Iess the City of Everel! trom any and all ctaims for damages, costs. <br /> ' exnenses. or causes of action that may arise because ol installation <br /> � /�'�� znd maintenance ol the improvement or other righhoi-way use hereto <br /> '�"'�.�""'���� '3 z/S applied for and lurther agrees to remove same upon no�ice Irom the <br /> ApprevedforConstruction ale <br /> Ciry a to replace public property damaged thereby. . <br /> Q,�� {� ' c.,��� 1 �, �7 <br /> FW�L INSPECTION Date ��.�/�—�S <br /> l.pprcved as Consiructed �Iure ol t Date <br /> everett PUBUC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED V`/ITHIN <br /> � 3200 Cedar Street iB0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> Fverett. lVA 9P201 BE DILIGENTi_Y PURSUED TO COMPLETION. THIS PERMIT MAY BF <br /> Phone: 259-8t37 5 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON ThIIS <br /> PROJECT O��ER 90 DAYS DURATION. <br /> i <br />