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:�„ <br /> �,/, �._ , Puo12 Wmu Perm�t• <br /> Date�Sl��� ` o�a,oso� • a' `-�-- <br /> � Appl.,;ation For _ <br /> pUgLIC WORKS PERMIT °°°'""'°'""°° <br /> ,o�a�«� 5 <br /> �eae noo�«e Pem 5 <br /> p.,i.,���o�� S <br /> xt�"'i1 <br /> ��9,� Prinl or Type Only <br /> .7y 2 !� <br /> y �� / r�i /�I eYr ,�de� IIG�� - lrl l�r J� L���o�-f- 9J'3G�.� ZJSS � ��7 Phone <br /> Owner Ma��ing Atldress <br /> K C� <br /> O LC O ���y Phone <br /> � y H � qpplicanl MaiGng Address Z�P <br /> � �� �]�y(,fi�in , s ��Ie�L.I r r�a��rlv� c,A �aco <br /> Describ=ProPosed Work � <br /> "�g W <br /> H � <br /> r ~y P;oject Adtlress 1�� known) ' � rr ^ —'�--�� H <br /> ty ti � <br /> o � <br /> �; q y p��zc;•tow�q)copies ol plans lor proposed wo�k� J�aw to scale and note ihe lollowing as app�ca e�. � <br /> � �'� • Property Lines • Centerline of sireel <br /> • Indicate Norih <br /> • Outline and dimensions ol all enisting and � ghow any proposetl grading changes <br /> Z H f/J proposetl sVu[tures on Ihe lot � <br /> y �N • Show measurements <br /> • Eaisting and P�oposed utilities <br /> 00 NOT W�ITE BELOW TNIS LINE O <br /> PERMITCONDITIONS � <br /> 1,All calis for inspeclion shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work sha�l be peAormed in accordance with lhis permit and current Gdy of Everetl DeS�gn and Constructio� <br /> Standards and Specitications. � <br /> '+� a.' 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � � � O <br /> �� � � •�l.< lcJcrG=, f��: .�. :,� �f%cy,c.Y u��' � <br /> C� //� <br /> ,���/�rr�= V/ <br /> � � ����-%��' O <br /> �_ a <br /> _ .� <br /> I ACKNO\NLEDGEIdENT OF CONDIiIONS <br /> f� The und���signed owneuapplicant hereby ag�ees Io hold and save harm- <br /> — less the C�ty ol Evcreti Irom any and all daims tor tlamages', cosls. <br /> � e•penses, or causes o� action Ihal may arise because of installation <br /> �'�. and maiNenance ol lhe improveme�� or other nghPol�way use hereto <br /> �pplied tor and tmther agrces lo �emove same upon notice trom the <br /> Appmved lor Construc�ion Date G�ly and to replace Public propeny dama9ed thereby. <br /> FINAL INSPECTION Dale Datc <br /> Si9naiwe ol APplicani <br /> ApprovedasConsirucled V✓ORK AUIHORIZED BY THIS PERMIT MUST OE STARTED WITHIN <br /> 0 rvemtt PUBLICWORKSOEPARTMENT 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTEF IS TO <br /> 3200CedarStreel BE DIUGEN7LY PURSUEO TO COMPLETION.THIS PENMIT h1AY B[ <br /> Evcrei�.\MA9B201 CANCELLED 6Y TNE GTY UPON ANY STOPPAGE OF WORI<ON THIS <br /> Phona 259�8�7o Pf10JECT OVER 90 DAYS DURATION. <br />