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Date c�"��, <br /> APPIiCaIiOnFor r��ni�� w�„w:r�rm,� _ ._ <br /> PUBLIC WORKS PERMIT �,nV �en� . u-����__ <br /> Pu�Lc WprF�fen <br /> Talei Fee S <br /> Print or Type Only �"ss�ooi FeApa,a S___� <br /> a�in���n„� S <br /> � <br /> �_}��►� i�� If�'��� <br /> Owner ��'"'—� Madmg Atldress � � <br /> City Zip <br /> � Phone <br /> App��Ce�� Mailing qddress <br /> City Zip —_ <br /> Phone <br /> Deacribe Proposad Work �� <br /> / —_ _— �� <br /> Projecl qddresa(II known) � �---- � <br /> � �� <br /> Alfach four(4)copies ol plana lor proposed work- Drew to acale end note the lollowing es applicable� � <br /> • Property Linea <br /> • Outllne entl dlmana��ns ol all existing end � Centerline ol sireet � <br /> proposed sfrucWres on the lot � �ndicAfe Norfh � <br /> • Exlsting entl propnsea utllilies � Show eny proposed grading changes <br /> • Show measuramenfs <br /> DO NO7 WRITE B�LOW THIS LINE m <br /> PERMIT CONDITIqNS A <br /> 1. Ail cells lor inspection shall L•e mede 24 hrs. in advence � phone 259-8815. y <br /> ?, A��work ehall ba perlormed in accordance with fhis perml�end currant Cily ol Evere11 Design antl Construction <br /> Sfandarda end Speclficaliona. � <br /> 3. Cell Loca�ion Underground Service 48 hrs. belore you dig.TO�L FREE NUMBER 1•800•424•5555. • <br /> �L�6'!�L GcJa.F'�S ��,�7iT �T ' , � <br /> �C E"�C,i,EE.O � <br /> �i1-$-' <br /> . <br /> `�"/c.� � <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The untlersigned owner/app�lcent he�ehy ag�ees to hold nnd save harm� <br /> less Ihe Cily ol Everetl Irom any and all cleims for tlnmages, costs. <br /> expenses, or causes of action that may erise bacnuse of inslallation <br /> and maintenance of the improvement o� other n�hl�o�-w2y u9e herelo <br /> Approved lor Construcllon applied fo� and Iwther pgreus lo remove sarna upon notire Irom the <br /> Dcle C;�y and to replace pul>hc prnn��l,�dama�ed Ihereby <br /> FINAL INSPEC710N <br /> Approvetl as Construcled Dnta <br /> PVP/YII PUBLIC WOqKS DEPARTMENT Siynalure ol qpphr,ant — ---- <br /> WORK AUTHORIZED BY THIS PEqMIi MUST BE STARiED WIiFiIN <br /> � 3200 Cedar Slreel 180 DAYS OF DATE PERMI7 IS ISSUED AND iHEREAFTEF� IF TO <br /> EverP��, yyq ggp�� BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Phone� 259-8815 CANC[LLED BY 7HE CITY UPON ANY S7OPpqGE OF WpR1;ON THIS <br /> PROJ[C7 OV[R 90 DAYS DURATION <br />