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� Cs1 � <br />,o�x <br />C H <br />9�3tn <br />H Z� <br />�C C� <br />H �1 <br />o xo <br />�7 H � <br />V1 H <br />y C <br />x�3 <br />h7 Q v1.y. <br />Y`J y <br />0 H <br />��� <br />c� � c� <br />ay� <br />r z <br />yy <br />gd� <br />��M <br />H O c�n <br />�� ; <br />� �s � <br />`!,€'�' I <br />'� w <br />�ate �/��/9� i <br />,. <br />a <br />PUB�ic <br />� <br />'rint or Type Only <br />—��,Z!]_ <br />Uwner <br />�eSC�be Prcposed N'ork <br />'rojed ACd�ess �il know�n) <br />TQ POSTIN <br />Application For <br />WORKS PERMIT <br />Atldress <br />AEtlress <br />n�� �2��c <br />I o�oi.c �+�m.a vamn . �J � /zs� <br />�al��h�—_"iaoDeoi.��—j =(bGL^.-F __ <br />/ <br />Pueec No�.v��e 5 <br />,a,:�«< <br />�ess noo� �: • va�e 5 <br />eaa�ce o�e 5 � ���� J'S�" <br />Zv�- <br />5/06/91 12 � 4:!�4`LL�'iCR�oB.=1 <br />/ <br />U000^b�bo <br />BLD"u� 4576.50 <br />�. <br />M'.�BO.DO <br />F�ri cH sa.�� <br />HOD02°205 <br />�uacn tow (dl copies of plans lor proposed work - Drativ l0 5:ale antl note Ibe lollowing a5 appLcable� SGWER :3D.00 <br />• Prooerty Lines • Centerline ol sireet <br />• Outline and Almensiocs ol ai! eaisting antl •�ntlicate North Ff��ii' <br />proposed strucWres on Ihe lot • S�ow any proposetl qratli�*1,086B�c�� <br />• Existinp and proposetl utilities • Snow measuremems CST E5 5141'.5`� <br />-DO NOT WRITE BEION' THIS LINE �.+WjF�$F' SS�.00 <br />PERtdITCONDITIONS �j!�C}; !??67,�� <br />i. All calis lor inspection,hall be made 2a hrs. in advance � phnne 259-8810. <br />2. All work shall be pedormed in acc�rdance with Ihis permit and curre�t City of Everett Design and Construction <br />Standartls and Specifications. <br />3. Call Location Underground Service sB hrs. betore you d�g. TOLL FREE NUMBER 1•800•424•5555. <br />� <br />�,� Q 11�1 G�- Z-�4-- 9 � <br />�proved lor Corslrupi� Date <br />��U w%i� 5 i <br />Vl.l INSPE'CTION� �ale <br />_proved as Constructed <br />everett PUBLICWORKSDEPARTMENT <br />3200 Ceaar Slreet <br />Fverett. \VA 98201 <br />� Phonc:'e55�88t0 <br />�_� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />;::t:k; <br />W <br />r <br />� <br />Y / <br />W <br />O <br />♦ <br />Z <br />O <br />The undersigned owner/applicant hereby agrees to hold and save �arm- <br />less tne City of Everetl Irom any and alt claims lor damages, wsts. <br />ezpenses, or causes ol action Ihat may arise because oi installalion <br />antl mamtenance ol ihe improvement or other righl-o4way use hereto <br />ap0lieC lof and ���nher a9reC5 lo remove Same upon notiCe Irom lhe <br />Cily and to repla[e publiC property damageC Ihereby. <br />����,,. �-„��Q � M <br />Signature of ApplicaM Da�e <br />N'ORK AUTHORIZED ^Y THIS PERMIT IdUST BE STARTED R9THIN <br />180 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO <br />B[ DILIGENTLY PURSUED TO COb1PLET10N. TNIS PERMIT h1AY BE <br />CANCELLED BY 7HE GTY UPON FtJY STOPPAGE OP WORK ON THIS <br />f ROJECT OV[R 90 DAYS DUHATION. <br />