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PUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe P�oposed Work <br />Prolect Address 1�� known) <br />� i ��� <br />r����i��. w���� ve��m`�i .% <I_ 'i ._, - �"- - � -- - <br />niao o»n�.. ��SJCJ�—_ <br />Less �ool Fna Pnia s— ' <br />mi.v..Ovn S L��� <br />AUech four (4) copies of Dlens lor prnposed work � Draw to scele end oote tha tollowing es eppllcnb�e�. <br />• Property Llnes <br />• Outline end dimensions ol all oxistin{7 and <br />proposed s�ructures on the lot <br />• Existing end �r�posed utlllties <br />252-1166 <br />— Phone <br />• Centerline of street <br />f Indicato North <br />• Show ony proposed Brading chan�es <br />• Show measurements <br />PERMIT CONbITIONS <br />1. All calls lor In=peaUon ahall Ae made 24 hrs in advance - phone 259'6815. <br />2. All work ahnll Ge Perlormed �n eccordance with Ihis parmit an7 cwrr�nl City ol EvereU Design and Construction <br />Stenderds and Spacilicetlons. <br />3. Call Locetion Underground Service 48 fus. Ue�ore you dig TOLL FREE NUMBFR 1•800•424•555 . <br />FUBLIC WORKS DEF'ARTMENT <br />3200 Cndnr S�reet <br />[verett. W� `�820t <br />Phone�.259�H015 <br />ACKNOWLEUGEMENT OF CONDIiIONS <br />The undms�gned owneNnpplicant hereby agrees lo hold and save ha'm' <br />icss iM1e Cny ol Everatl Irom any and ali clnims br demeges cosls, <br />ezpe�s^_s, or cnuses ol action ihat may ariso because of installntion <br />;nd malnlenance ol ihe improvament or other right-ol�way use here�o <br />�pgLod tor and Wrlher aBrees lo remove same upon notice Irom the <br />Ciry and �n /icplace publir, proP���Y dameged thereby. <br />/' �i u� ��^�� a� � <br />$ I�AIufC 0� Apn��C00� <br />WOFK AUTIIORIZED BV THIS P[RMIT MUST BE STARTE WITNIN <br />190 DAVS OF DA7E PERMITIS ISSUED AND THEREAFTER IS TO <br />PE DILIGENTLV PURSU[D TO COM��E �'7N. THIS PFRMI7 MAY BE <br />CANCCLL[D OV THE CITY UPON �NY Si., FPAGE C1F WORK ON THIS <br />PfiO.lf C;l OVER U01)AVS DURAiION <br />