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pa�e ry/s=� <br />Appllcaflon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />ru <br />ApPlitnnl <br />Describa Proposed Work <br />Project Addreas (II known) <br />�G �ld(o SE -G/�z'�/iJl/lcc u� <br />Melling �ddress z City <br />Malling Address City <br />/itlSTfJc� aS' !.�/iG� �c�ic,r'�A <br />sn,4._ �;t�-s s�- _ta. <br />Pubbc Woih� Ve�mit • �J — � �� <br />B�Gp Oao� • � ��_ <br />v�eim wo�w. v« — <br />Tot�l iae j <br />Leu Aon� F�� Vu0 s_ <br />B�I�nceOm = �•'�n� <br />7s9�9 <br />E7 �< 3sS�� <br />ZiP PY,one <br />ZiP Phone <br />Attech four (4) copies ol plans lor proposed work • Drew to scalo and note Ihe iollowmg as apnl�cable <br />• Properry Linas • Centedine oi,Irecl <br />• Outli�ie nnd dimensions ol all existing and • Indicate North <br />proposBd ahuctures on the IOI • Show any pwp;,sed graAmq changes <br />• Ezisting end proposed u�ilitles • Show measwemenis <br />PERMIT CONDITIONS <br />1. A!1 calls lor Inapeclion shall be made 24 hrs. ii� ativance � phone 259•881 5. <br />2. All work shall be performetl in eCCordance with ihis permit antl curtent City of Everell Design and Construc�ion <br />Slandards and Specilications. <br />3. Call Location Undergrourd Service 48 his. Lelo�e you dig. TOL� FREE NUMBEH 1•800•424•5555. <br />ApproveA for Conshua�on � ' Da(e <br />%-Z�.f'fv <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everett PUBLIC WORKS DEFARTMENT <br />� 3200 Cedar Sireel <br />EverelL 1Y4 38201 <br />Phono:259•8815 <br />ACkNOWL[UGE6IENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />The under,�qneA owner/apphcant neieby agree5 to h01tl end 5ave herm� <br />less Ihr. Qty o� Lvr.retl Oom any and all claims for damageM costs, <br />expenses, or causes ol ar.lion Iha� may anse beceuse ol ins�allation <br />and maintenance oi the improvement oi other n�ihl�o4wey usa herelo <br />apphed lor end further agrees to removn same upon notice Irom Ihe <br />City place publ property domaged thereby, <br />✓ � ,���G �S� <br />Si lure ot Applica Uate <br />ORN AUTHORIZED BV THIS PERMIT MUST BE STAqTED WITHIN <br />1B0 DAVS OF DAiE PEfiMIT IS ISSUED AMD iFIEREPFTER IS TO <br />BE DIIIGENTLV PURSUED TO COM1!PLETION. THiS PERMIT MAV BE <br />CANCELLEO BY TFiE CITY UPON ANY' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />