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�8t0��✓ n�eeewo�wepeimit• e7J� �eJ�G <br /> Application For e�aa.oen� •_ <br /> PUBLIC WORKS PERMIT �eTol�FeeF� s <br /> le�a�PDI Fea PLO 5 <br /> Print or Type Only e.�,�«o�, s 7� <br /> /�.��� .C�EC, 8/.53� <br /> ���nY B�AN T-STE�mAN /�/�/ Faurl E dFRETT _3S3 -�73 S� <br /> Owner Mailing Address City Zip Phone � <br /> I�ELT/� I�AciF�L Lc�'T �p aoX l29 �FiVmo�2t 9�OZJ �/-6/Z3 � <br /> Applicant Mailing AdCress City Zip Phone �� <br /> Describe Proposed Work (o <br /> �� W4re�Z if7ivi�J FXTfn/S/D/.� E'LC�OT �' PALIs9 <br /> H H <br /> � � <br /> N � <br /> Proiect Addrese�il knownl EL t iDT GIIAY `f' f�q C/Yl �� �Yt� � � <br /> � � <br /> Attach lour(4)copies of plans for proposetl work- Draw to scale and note Ihe lollowing as applicahle: � � <br /> • Property Lines • Centedine o1 street <br /> • Outline and dimensions ol all exlsting and • Indicate North � Z <br /> proposed structures on the lot • Show any proposetl gradin�changes <br /> • Existing and proposed utilities • Show measurements � � <br /> � N <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O O � <br /> 1. All calls br i�ispection shall be made 24 hrs. in advance-phone 259-881 5. � .�- <br /> 2. All work shall be performed in accordance witb Ihis permit antl curreN City of Everntt Design and Construction �, �..� <br /> Standards and Specilications. N <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424•55�5. t+ <br /> f� TO BE Co.rls,-�'UciFo �E.c� A<�.��.f'o✓E� l�.PGul.�slG� � v�i <br /> DArEO /�-/7-f�� . O � <br /> � � <br /> Y/ y� <br /> a � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unders�gned owner/eppiicant hereby agrees to hold and save harm� <br /> le5s Ihe Gty ol Evere�t irom any and all ciaims for damages, costs. <br /> expenses, or causes of act�on that may arise because ol instal�ation <br /> .�/�' /�G / /2�7 � and mainlenance ol ihe improvement or olher ric�h�-ol�way use hereto <br /> _��-L1��� 'd"T��--• � applied lor and further agrees to remove same upon notice Irom the <br /> AGProvr!d for Cons uclion ' Da�e Cily and to replace public property damaged thereby. <br /> ` <br /> •� ?-34 ��� v / � � � <br /> FINAI INSPECTIUN Dale � /� - /t - / '� /-�<^— <br /> AGP�oved os Con^VucteA Signa(urE o Applican� Data <br /> eve«•tt PUBIIC WORKS DEPARTA7ENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIh <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEtiEAFTf.R IS TO <br /> Lvcrctt.VJA 98701 BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMi i MAV BE <br /> Phone: 259�8815 CANCELLED BV THE GTV UPON ANY STUPPAGE OF WORK ON THIS <br /> PROJECT OVEF 90 DAYS DURATION. <br />