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i <br /> Date � � , � �,,��<����,�,��,.���,�. .��f. � <br /> pmp Den� • � �-/��� � <br /> Applicalion For � I <br /> PUQLIC WORKS PERMIT '°°ro,aF�'.`°a S , <br /> le.ssAno� icePmU $ <br /> l'J[�� <br /> palnnrr Oue S <br /> ay Print or Type Only <br /> 'm4"'�H <br /> 9HN <br /> H �� �o4�a� � rr;r� Po ,�t o?l�� Ever� �J�'�o3 ,�59 -SO.P� <br /> H H Owr2 Mading Adtlress City Zip Phone <br /> �C n <br /> H X1 <br /> O SO <br /> �i1 H'�J <br /> N y� App icant hlailinc�Address Ci�y 2ip Phone <br /> � z /� ./ <br /> yd Descr�heProPose�WorK _�ICp�i! ('i�� ('���jj�(dt:i(� h�CC��Y�--('vl l�S�/t'�_NL_f�b.�_ <br /> OH <br /> H �g — — <br /> �� � <br /> z r+� - � <br /> yz n <br /> H y / 7�' 1f1� �/_P I..� <br /> gy Proled Address lif known� ___��f(p�t A � , <br /> H <br /> O t7 A� � t <br /> q Attach lour(4)copies ol plans lor proposed wak- D�aw lo scale and note Ihe lollowing as applica6le: <br /> � �'��" • Property Lines • Centedine ol s�reet ♦^ <br /> 1 <br /> z y y • Outline and dimension5 0l all e*islm9 :mA • Indicate Norih V� <br /> H O V7 � proposed shuctures on the lot • Show any proposed yradin9 chanqes , <br /> • Existing and proposetl u�ilities • Sl�,o�v measurements /y� ! <br /> W <br /> � DO NOT WRIT[ BELON'TIiIS LINE O <br /> PEFMIT CONDITIONS <br /> � 1.All calls for mspection shall be made 24 hrs.ir ativance-phone 259•881 Q � <br /> 2.All work s�all be pedormed in accordance wi�h Ihis permit and current City of Everztt Design and Conslruction <br /> Slandards and Specdications. <br /> ',v, � 3.Call Location Undeiground Service 4N hrs hetare you diq TOLL=REE NUMBER 1•$OO•424•JS55. � <br /> s ! <br /> O <br /> � � � <br /> r� I �UT �G1�� 1 (zL"1�� Y♦ <br /> �..,. ; �U��I C_ �—IO�ZI�'� �21"l lT— / <br /> `� — ��� {�(;�c�-- 0 <br /> � j��l �/( �/9 � Q. <br /> �~�'�,.� ACKNOWLEDGEMENTOFCONDIilONS <br /> Tl�.c undcisi9ned owner/applicant hereby agrees Io hold and save hann� <br /> � Icss ihe Clly ol Everett Irnm any and all claims lor d�ma9es, c�sts. <br /> eapenses. or causes ol aclion Ihat may �rise because of inStallalro�� <br /> � ..� ond inumlenanr.i� of the improvement ur othor ngh��ol-waY use her��to <br /> — aPPln,d !ui and Imih��� aqo,es lo iemove samc upOn ne�icc Lom Ihe <br /> Approved loi ConslruClion Dat� GIV,���d to irnlm:�•pul�hr piopc�ty dainaqi�[f R�ereUY. <br /> RNAL INSPLCTION Datc _._ —----- – —-------� <br /> Appioved as Gonsirue�ed Sinn.�iwr nl APPl�eant �'�O <br /> IVOHK AUTHOf71ZLD �\' THIS PERMIT M1tUST 6F STAR7[D WITHIN <br /> i,��•�i��t PUBLICWORKSDEPARTMFNT 160 DAYS OF DA7[ P[RMIT IS ISSUED AND THLREAFTEI7 IS TO <br /> � 3200CedarSirect pE DILIGENTLY PURSUED 10 COMPLETION. THIS PERMIT MAV B[ <br /> Gveiett,NA�H2O1 C�NCELL[D �Y TH[CIT1'UPON ANV STOPPAGL OF WOI:K ON 1 HIS <br /> Phnnr�.253-Uf3t0 PROJFCI OVtRDO DAYS DUR�ITION. <br />