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�B�e��y.3 TO P(!STING � �—C�3 amKwo...ne.mn. �/j Z�g/ <br /> AOVlicailon For e�ep ow • <br /> PUBLIC WORKS PERMIT °°°;o:.:'^ : <br /> ie���oo�r..r.a i <br /> en.M.o,,. 3 �SO��— <br /> Print or Type Only <br /> Jl,� 5���.t� �osrZlc�:���1�9ss��Ss�.�s9 <br /> Owne� Mqihng A�d�ess City Zip Phone <br /> �'NS r .T „ �, �. �, � , <br /> � � <br /> AOP�icenl Ma�hng qOtl�ess City Zip P�one <br /> �' I IIi IG�D�F oF A"S TL, <br /> Describa Proposed Work yuS A An e�e r W� O IJ N � <br /> �j�ir � I � �� ( `� $1�r Sewe✓ %iY �ue �u `r�+r 1 � uF <br /> -- W <br /> Proiec�Atltlressl�lknownl 0 O/ �, %Q20Z 9n.I ippoi — /£r0� � <br /> Aliec�lour�4)copies ol plens lor pmpOseE work�Draw Io scale antl nete Ihe lollowmg as ap0�icable � <br /> •Properry�ines •Centerlme ot street /A <br /> •Outl�ne ana dimensions ol all eustinB�^4 •InEicate Nort� V� <br /> pmposcd simc�urts on I�e Ioi •$�ow any propOSed QtadinS'hangM <br /> • ErieUnB ana owoosetl utilities •Snow mexsurem¢nts � <br /> �O NOT WRITE BELO\Y iM15 LINE O <br /> PERAl1T CONDITIONS <br /> 1.All calls lor Inspection s�all be maEe 24�rs.in ativance�phona 259•881 O. ^ <br /> 2.Allworkshall0apatlormeElnacrordancewit�IhiscermitandcurtenlCiryolEveretiDesignenCCanstraction � <br /> SlanGares and Specilicntions. <br /> 3.Call Location UnUerqrounE Sen¢e 48 brs bMore you tlip.TOLL FHEE NUMBEP 1•800�424•5555. � <br /> T lt.�,� To BE OcwC i�E2 Af'�,Po✓ED ftiP.✓ O <br /> D/9TED {�+.?,8•9j ���'�j' Ars���/,c c�, _ <br /> c;,,c/ �1•.a, Xclz.:: tr ✓re 9-a�.�/ti �/:��d Y-lz-Yj V+ <br /> O <br /> a <br /> ACFNOWLEOUEMENT OF CONDITION$ <br /> T�e untleisig�etl owner/aOPllcani hereby aqree5lU holU ana savC M1arm� <br /> � less Ine Gty o� Everett irom eny antl ail claims lor aamages. casts. <br /> �� p eapenses. o�wases ol edion Inat may arise because oi Installalion <br /> -// / ^ 8f1d lllTinIPOT�CB O��M1E�IIIO�OVPTQI1�0!O�hQ!fi011FObW0y USP IICIQIO <br /> �` 6 5 aoVlietl br ana 1urincr aprees to remove same uDo�notice Imm ine <br /> Appmv Co ru ' ��a Ci1y anE m replace ou ic pwperty�amapeE thereby. <br /> � / �� ri <br /> F A INS E TIO � �r�� <br /> AV�mve�AsLonsimcietl � Sign oiealAp icant Dale <br /> � PUBLICWORKSDEPABTMENT WO AUTHORIZED B TH�S °ERMIT MUST BE STARTED WITMIN <br /> 9POOCedar5lreet 18G OAYS Of OATE PERM�T IS ISSUE� ANO THEPEAFTER IS TO <br /> EverNt W�9B2ai BE DILIGENTLV PURSUEO TO COMPLETION.TMIS PERMIT MAV BE <br /> f�none P59�NB10 CANCELLEO BY THE CITV UPON ANV STOPPAGE OF WORK ON TNIS <br /> PROJECT OVER 90 DAYS�URATION. <br /> a' <br /> ':i . <br />