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Date 5/ 3 J�! <br />Application For <br />PUBLiI� W��K� �''ERM�T <br />Print or Type Only <br /><1�1���, � i' �- <br />— Mal�ing Ad <br />(� ll%/Jc>� <br />C,7� /jiii��t �6�';i <br />Describe Proposed Work <br />//��SiHc� >i� l(,'/���" i;/cc%'[-%-C 7/'�[-�"Zd%i�:� <br />Project Address (ii koown) <br />�'v / 7 3 <br />Pu�l�c Work; Permn� � �0 � <br />O' <br />BI4g. Dept p 1L. . ----- <br />Public Wads Foe S, '�A , p"O _ <br />Tolal Fee — <br />Less Ap�� Fee Paltl 5 -- <br />dalanca Dua <br />$i %O '� <br />e %s'/% <br />-j���'� % %�I'�/ iSS-uu�:, <br />Phona <br />Phone <br />i C i �-� (�'� '�� �I ' <br />Attach four (4) copies cf plans tor proposed work - Uraw to scale and �ole.� Ce°��e�ine of sUeE�cable: <br />! Property Lines • Indicale North <br />0 Outline and dimensions of all existing and � ghow any propos�d grading changes <br />proposed structures on the lot • Show measurements <br />o Existing and proposed utilities _���Y�� <br />� <br />� :. � J, <br />PERMIT GONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advar,::e - phone 259-881 5. <br />2. All work sh..11 be performed in accordance with lhis Fermii and :urcenl City oi Everett �esi9n and Consiruction <br />Standards and Speciilcations. <br />3. Call Localion Underground Service 48 hrs. belore you diy. TOLL FREE NUML'ER 1•800•424-55 . <br />�o� <br />(�L° �' i ��,�� <br />FINAL INSPEGTION / ��, <br />;,pproved:�SConstruc °d l� <br />everett FUBL� rORKS 0 <br />� 3200 Cedar Stree� <br />I Everetl. NJA 98201 <br />Phon�.'. P59-8615 <br />�� <br />�� � � <br />���-�(�-- J -.1 f'o� <br />��7 <br />Date <br />A.CKNvVJLLGGEiv1ENT OF CONDITIONS <br />1�,,e un�crslync�d ovmed.�pplicant hereby a9rees to hold and save harm- <br />�E�,. �he City of Everetl irom ony and all claims tor damages, costs, <br />e;:penees, or causes of acCion thal may arise 6ecause of insL�llation <br />and n�a'ntenance ol the improvement or other right�ot-way use hereto <br />p�Rlied.for and furth r agrees te remove same upon notice Irom ihe <br />�ity and�to replace blic property damaged thereby. <br />�,�, `� % �� S->> S`/ <br />]I IIGll11C V� �YY�•""••• <br />'ORK AUTHORIZED RY 7HIS PERMIT N�UST BE STARTED J�lll'HI <br />180 DAYS OF DATE PERMIT IS ISSUED AND THER�AFTEH IS TO <br />BE DiLIGEN7LY PURSUED TO COMPI-E710N. THIS PE�.rq1T MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF'JJJrIK ON THIS <br />P(iOJGCT OA�ER 90 DAYS DURATION. <br />� <br />r. <br />C: <br />