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oa�e�d . <br />Application Por <br />PUBLIC WORKS PERflAIT <br />Print o� Type Only <br />Ownei <br />APPI�ce� 1 <br />Addres9 <br />Mniling AdAress <br />City <br />C.�y <br />nunnr Ylor4e Permitj �"-��O_�/��� <br />e�aa o.oi . fr.l��! i�'2J�' _'_ <br />Punbc Wo�4 Fee <br />inni Fae i <br />Lnfe �PVI i�� °ud { ' _ <br />B�i�nce Due { �� � <br />_ 830^/ <br />/SS' �G.3-o.3/6 <br />Z�P Phone <br />Z�P Phone <br />� J / <br />Describe Proposed Work _ � O� _ J,I Ct+ r(q ��� J <br />Project Addresa III known; _ _7 L�� `�a10 =�ST ,5�: <br />Attach lour 141 cc.�'sc ol plane lor proposed work � Draw to ecete anA nole Ihe lollowing ns epphcoble <br />• Prope�!y Lines • Centerline ol streel <br />• Ootlinu antl dimensions ol all e�ieting end • InAicnle No�ih <br />pmpoeed s�ructures oc Ihe lot Y Shovi any proposed �mdiny �•hanyrs <br />• Exl9tinp end nrocoseA ulilities • Show measuremenis <br />uV rvVI WNllt tltLUW THIS LINF � <br />PERMI7 CONDITIONS <br />1 All cnlls lor inspeclion shall he made 24 hrs m advance - phone 259•881 5 <br />2. All wmN �hell be parlormed in eccordancn wilh Ihis p�rmil and cmrenl QIy ol Evvrult Des�9n and Construction <br />Standards end SpeciGcetions. <br />3. Call Location Unde�ground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•4Z4•u55$. <br />4. This lo[ depende on a lift e[a[ion for sani[ary aewer yervice, The Ci[y has <br />not ar.cepted the lif[ s[a[1on ior apera[in; and main[enance ne of [hla da[e. <br />Occupancy of resldence will no[ �e allr ied until the Ci[y accepte the lif[ <br />sta[ion. <br />5. Uown epou[e trom [he house are [o be [if;!it-lined Co the curb drafn. <br />6. Any grading of [his lot ie [o be don� s�� ae no: [o impact the adjoining lots <br />wi[!� rain-wsr.er run-off. <br />7. Sidewalk is new end unbrokeii. Any demapc te it wfll. requfre repincemen[ by <br />[he applicnnt. <br />Z � <br />qpproved es Conslruclatf > -" <br />UPverr�, PUBLIC WORKS DEPARTMENT <br />32�� CPddf $�1PF� <br />Everelt, Wq gP^C1 <br />Phone�.259�8915 <br />W <br />� <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMLNi Of CONDITiqNS <br />The undersigned ownenapplicenl hereby egrees lo hold end exve harm- <br />!esa the City of Everatl fram eny end all cleims lor demages. ^osts. <br />eepenses, o� ceuses cl achon ihat mey ariea 6eceuse oi installatlon <br />96 entl memtenence ol Ihe improvement or other righPof�wny use he�eto <br />anplletl lo� end furlhei agrees lo remorn sxme upon nolice Irom Ihe <br />Dnle Cilv and to replar.e nuthc oroperty damaged �hereUy <br />�e� -� // � ��./��i��y . / i�! � - <br />/C <br />Slgna�ure o� APPhcxnl / Datr <br />YIORK AUTHOR12E0 BV THIS PERMIT A:UST BF STARTED WI*HIN <br />1B0 UAVS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TJ <br />BE DILIGENTLV PURSUEU TO COMPI ETION THIS PERMIT MAV BE <br />CANCELI.ED BY TH[ CITY UPON ANY SiOPPAGG OF WORK ON THIS <br />PaOJEC7 OVER 90 DAVS DURATION <br />