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Da te�L_G J � �� <br />� � <br />Applicotlon For <br />PUBLIC WORKS PERMIT <br />Print or Type On�y <br />�uin � �.� -r�c <br />ailing Adtlrnss Cily <br />siling Address City <br />Dascribe Propoeed Work ��_. <br />Prolect A� �reas 111 known) <br />PuM¢ Wm�e Pe.m'�il •� C%" J`���� �•�•�7�� <br />emo oso� • Q `±� yl:/ `� '��+ <br />Pue��c War�� Fse f <br />Tol�l Fe� <br />Lee� �p0� hs P��d f <br />B�i�nre Oue i j��— <br />„ / C� <br />u,�x ,p G 3 -d.�/ <br />Zlp Phone <br />Z�0 Phona <br />� //�/ �n.i�f fF � <br />Attach lour (4) copies of plar3lor p�oposed work � Draw lo scelr, end note the �ollowing nv aUP�icah!e <br />• Property Lines • Centeillne ol streel <br />• Outline and dimensions ol ell existing and • Indicete North <br />proposetl struclure9 on fhe lol • Show eny prp� osad y�rdmq cnanges <br />• ExiStiny xnd propo9ad uJIAi05 • Show mee9urnm5nls <br />PENMIT CONDITIONS <br />I All CAllg lor inSpeCliOn Shnll be made 74 hrs in aavance � phone i�9•88� J <br />2. All wo�M shell 6e perfo�merJ in ar.cordance wilh Ihis permil and r�drrent City ,i 1 irr,-�n f-,ign ard Co���slru,:hon <br />S�enderd9 entl Specificelions <br />3. Cell Locelion UndergrounA Service 4A hrs. be�me you dig. TULL FREE NUMBER 1•BGO•424•55y5. <br />4. Thie lot depende on a lift station f�c eanitary aewer aervice. The City <br />has not accepted the lift station for operation and maint�nance ae of this <br />date. Occupancy of :esidence will not be allowed until the City accepts <br />the lift etation. <br />5. Down spouts from the house are tc tw tight-lined to the curb drain. <br />6. Any grading of this lot is to be done so ae not to impact t!�e adjoining lots <br />with rain-water run-off. <br />7. Sidewalk is new and un6rokcn. P,ny 9amage to it will require replacement by <br />the applicant. <br />PUBLIC WORKS DEPARTMENT <br />3200 CeAar Streel <br />Evere��, 4VA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGE�AENT OF CONDiTIGNS <br />The unde�5�gned owner/aOPllcant hereby egrees to hnld enA savp harm� <br />less the Gity ol Everett Irom eny end all cleims loi dem�ges, o�sts, <br />expenses, nr ceuses of +-Ilon Ihat may erise becnuse ol installa;�on <br />nnd mamienence ol Ihe improvement or other nghPol-�vny use neiato <br />epplieA lor nnd lu�lhei ayrees to temove soma upon notice Pom Ihe <br />Clty d 1� replar.e pu6lic piopecl� damagetl ihrreby. <br />� r � <br />, � ,,� : ` G�� �;� �� <br />ig atur«r o� An �� ant oa�e <br />WORK AUTNOfiIlED V THIS FERMIT MUST BE STAqTEU WITHIN <br />1A0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFiFR IS TO <br />BE DILIGE�TLV PUHSUED TO COMPLf.TION TFiIS FERM;":' MAV BE <br />CANCELLED BV THE GITV UPON ANV STOPPAGF OF WORM ON THIS <br />PROJECT OVER 90 DAVS DUF4TION <br />