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Date—�� ' � ' <br />Appllcation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />Describe Proposed Work <br />��\�V�.�'� % i � i <br />Mailing Address <br />MaiPnp Address <br />C UnJ.� l /�'UC_ i <br />��D1�, n�`F� <br /><� � �/ l _ l <br />� i`--� LULY'�-�� � <br />� <br />cny <br />Pu�6c Woihs Pa�mi�� �J�/� <br />J � � 9 7 <br />Bm? Deot. _����� r '�- <br />vomia wort. Fee 9 —� — <br />Totel Fee <br />Lese A00�� Fee Peid S ^�` <br />daience�ue $ <br />�o� �_� � � ? _ C� �Z � c1 <br />Phone <br />Phone <br />cc F= SS <br />Prolect Address (ii known) `�" " " <br />Attach four (4) copies ot plans for proposed work • Draw to scale and nole Ihe lollowing as applicahle: <br />• proDarty Lines • Centerline of sticet <br />• Outline and dimensions ot all ezisling and • Indicate Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls �or inspection shall be made 24 hrs. in advance • Phone 259•881 5. <br />2. All work shall be perlormetl in accordance with ihis permit antl current Cit/ of Everett Design and Censtruction <br />Standards and Speci�icalions. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />7�raac o� �Ile� � s �o �-lblo� al� ere� <br />roved for Construction � /� � -Uaie <br />���� y;� ,_�_,�-d-y <br />�� v � oa« <br />FIN WSPECTION <br />Approved as Constructed <br />everMt PUbLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, NJA 9G201 <br />Phonc:259-C81.5 <br />ACKNOWLEDGEMENT OF CONDITIOP'S <br />W <br />� <br />� <br />N <br />� <br />� <br />� <br />N <br />O <br />a <br />The undersigned owner/applicaM hereby agrees to hold and save harm� <br />less the City ol Everett from any and all claims for tlamages, costs, <br />expenses, or causes of aclion iha� may arise because of installalion <br />and maintenance ol thc improverr�eM or other iigM•of�way use hereto <br />applied lor and turther agrees to remove saine upon nutice Irom lhe <br />City and to replace public properry damaged thereby. <br />` �,�.� � d <br />����N�-�'��� a-'' 1 1 2 � <br />Slgnature of Applicant Dat <br />WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />BE DIDLAGENTLY�P 1R UED TGICOMPLE�TIO J�THISEPERMIT MAY BOE <br />CANCELLED BY TF+E CITY UPON ANY STOPPAG[ OF WORI<ON THIS <br />PHOJf_CT OV[R 90 DAY3 DURATION. <br />z <br />0 <br />� <br />� <br />m <br />.. ., <br />--� T <br />., � <br />N 2 <br />m <br />V <br />mc <br />n <br />0 3 <br />-� z <br />S -� <br />m <br />.o z <br />c <br />-. <br />rx <br />., .. <br />-� in <br />-� <br />T <br />oD <br />-i m <br />x <br />m -� <br />� <br />or <br />�� <br />C N <br />m� <br />z c-: <br />-i r <br />m <br />a <br />A <br />