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Date�7 /O �3Ca13 % <br /> Pu�M1CN�o�ASPermn♦ � <br /> Application For ama oem.•_ �� <br /> PUBLIC WORKS PERMIT �„n;o,aF�;F��,� -- <br /> less M1ocl f'ee PaN S <br /> Print or Type O�ily ea�,,�«o�� s 2-0"' <br /> _c��i�p,���,��, �s��c�� �,�t�e� /� / <br /> Owner U Mailm9Address ��/� ,���//�r/�`� <br /> C�ry Phone <br /> Applicant A7aiting Address �-^—""'—�_�� <br /> City Zip Phone 3� <br /> _ �=y�� 1��� 57_��� % �`�'� <br /> Describe Propesetl Worh _ Vyyyn� <br /> / / (�(L.� <br /> Prolect Address(if known) C��l.� - 2.r.�p D�, SE — � <br /> Altach four(4)wpies ol plans lor proposeA work- Draw to scale and ncte �he ie�luwmg,; applicaL�le: � <br /> • P�operty Lines nv� <br /> • Outlir.e and dimensionc ol all existin and '� �enie:�me of s�ree� � <br /> 9 • In:;;,��� f.�.: . <br /> proposed structures on Ihe lot • Sh<;r� a, y p�,�pp,ed gradinc�changes <br /> • Existing and proposed utilities • Shr,c m_as.�rr,�-, <br /> t is <br /> DO NOT WRITE BELC�;i��� N� m <br /> PEFMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 2J hrs.in advance�phon,, 259•�y$!0. <br /> 2,All work shall be pedormed in accordrmce with this permit and cunoni Gity of Evcrett Design antl Consiruclion � <br /> Stantlards and Spocllications. <br /> 3.Call Location Underground Service 48 hrs.befo�e you dig.TOLL;=REE NUy1E�ER 1•800-QQ4-5555. <br /> � <br /> 4_ANY CHANGS IN THE DRIVEWAY CUT MUST Bfi APPROVHD O <br /> BY THE PUBLIC WORKS INSPECTOR. <br /> 5.CONNBCT I'i0WN8pOUTS TO P'iJSLIC DRAINAGE SYSTEM. � <br /> B_KEEP CITY SPRfifiTS CLSAN AT ALL TIMES. <br /> 7.ANY DAMAGfi TO THE CURA AND SIDHWALK WILL SE REPAIRED //R <br /> TO THfi SATISFACTIOh Cc 'PHE PUBI�IC WORKS D�pT. V� <br /> O <br /> a <br /> ,'�1�,� ACKNOWLEDGEMENT OF CONDITIONS <br /> �� T �•� ersi�neti owne�/applicant hereby agrees to hold and save harm� <br /> � �� �e City ol Everelt trom any and all claims lor damages, cosis, <br /> �� ^. isec or Car ?s o� aCiion lha� may ari5e beCaUse Of inS�allaiion <br /> ��� � _ 1 _ �� ai,,, maintenana ' ihe improvement or clher right�of-way us= hereto <br /> Approved lor Conslr ion / Uate �pPlied (or anC ar agrees to remov� same upon notice Irom the <br /> / City and to replac, blic property damaged thereby. <br /> �_/<</G l/ 7 -/S' - Fj i <br /> cc' �-. <br /> FINAL �NSPECTION Date p �l� <br /> Appro�•ed as Consiructed - -zG' 1 I <br /> Signalurc o pplica Dale <br /> evcmtt PUBLIC WORKS DEPARTMENT WORK AUTHOR12E0 BY TNIS PER�d17 MUST BE STARTED WITHIN <br /> � 3200Cedar5lieet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,Wq g8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BB <br /> Phone:259�BR10 CANCELLED BY THE CITY UPOIJ ANV STOPPAGE Cr WORK ON THIS <br /> PhOJECT OVER 9p DAY� DUR�TION. <br />