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i <br /> �-��s ---, ,_ <br /> Date � � P�oo��No,�s Pa, --{�j�t� <br /> Application For emg oea�.• �,�.�J— <br />� PUBLIC WORKS PERMIT Pu�TotalPeeFee g - <br />� Less AO���Fee Paia S <br /> Balance Due 5 <br /> Print or Type Only <br /> Owner 'lin ress City Zip Phone <br /> Applican� Mailing Address City Zip Phone <br /> Describe Proposed Work 1 ��� � � J.�. � <br /> ��s - -�ry W <br /> Prelect Adtlress(il known) �� <br /> C � <br /> Attach four(4)copies of plans for proposed work- Draw lo scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all exisling and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be periormed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � �`'��UI��'J 9-�a-88 Q <br /> ��*� �... <br /> � <br /> � <br /> I� <br /> i <br /> ACKNON'�.cUGcMENT OF CONDITIONS � <br /> The undersigned ow,�er/epplicant hereby agrees to hold and save harm- <br /> less the City ot Everett irom any and all claims for damages, cosla . <br /> expenses, or causes ol action lhat may arise bec2use of installation ��, <br /> and maintenance o( Ihe improvement or other right-ohway use hereto ' <br /> appLed for and further agrees to remove same upon notice from the � <br /> Approved tor Consiruction Date City and �o replace public iiroperty damaged ihereby. <br /> FINAL INSPECTION Date . <br /> Approved as Constructed SiStnature ol AGP���ant Date <br /> WO�K AUTHORIZED BY THIS PERMII' MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS (1F DATE PERMIT IS ISSUED AND THEREAFTGR IS TO <br /> � 3200CedarStreet BE DILIGEhiLY PURSUED TO COMPLETION. THIS ?ERMIT MAY BE <br /> Everett.NJA 98201 i CANCELLEC BY THE CITY UPON ANY STOPP�GE OF WORK ON THIS <br /> Phane:259�8810 PPO-1ECi OVER 90 DAYS DURATION. <br /> � <br /> � <br />