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Hc�'� <br />x '.1 <br />Cs1 <br />H <br />aHf~i� <br />�5y <br />HSh�-i <br />FC f� <br />H xl <br />'��IH� <br />VJ N <br />C+7 O � <br />OHd <br />�^�g <br />Y, V � <br />� H � <br />H <br />Ny <br />g�' <br />H <br />C] tCy V1 <br />C�7 <br />�H� <br />H O Cn <br />Date��ni• I�� IHBG <br />ApP�ication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ciiy <br />3AML AS ABr.'L <br />Appllcanl Mailin9 Address Crty <br />Zip <br />Zip <br />� - -,.�y <br />,..,���.,,�,.:,...,�,�,. _� �- �< <br />����:,� �,,,,� . - - ��� � <br />F•„�,� � ,v�„" ��a S <br />im.,�r.x --- <br />ir�s nnni irc �a�u 5_. _ <br />n.,�,..��„ n�„ S <'. �-". a <br />53• <br />Phone <br />Phon� <br />�� ��L/ ,v 3 bec/ . � /z hAt�4� �/ � <br />DescriheProposed Work �S/�+. iL'�" y q 2� 'YyB � w!� ✓ll�li✓s �'+� <br />.� <br />��> z <br />Prolect Address (il knownl �U�G9 — .L�E�- E"�G y' �L ✓n _ <br />i <br />Attach lour (�) cOpies ol plans lor proposed work � Draw to scale and note Ihe following as apnlicaUlv. <br />• Prnperty Lines • Centedine ol siree! <br />• OWline and dimensions ol all existin9 and • Indicale Norlh <br />proposed siructures on �he lot • Show any proUosetl yratlin9 �nancJes <br />• Existing and proposed ulilities • Sh�w measurements <br />/� <br />FINAL INSPI <br />Approvetl as <br />evMcll <br />e <br />DO NOT WFITE �ELOW 7HIS <br />PERMIT CONDITIONS <br />t. AII calls lor inspedion shall be made 2a nrs. in advance � n��one 259•881 5 <br />2. Ail work 5hali be periormeo in accortlance wrtn mis permit an�i cunenl Cily ol C.c�eL' D�:s�gn and Consbucbo�� <br />Standartls and Specilications. <br />3. Call Lawtion Underground Service 48 hrs. 6tlore you dip. TOLL FREE NUTAOER 1•800-424•5555. <br />✓ +i � <br />� � <br />� �9�t��' <br />� Dalc <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />e����n. w� sdzo, <br />Phone� 25n.8f315 <br />ACKNOWLEDG[�dENi OF CONDITIONS <br />W <br />� <br />� / <br />e <br />� <br />� <br />� <br />a <br />The undersigneU owner/appl�can� herchy a9rec510 holtl and save haim- <br />less ihe Qty ol Evere�t Irom any antl all claims lor tl�ma�jes, casts. <br />expenses, oi causes af action ihat may arise hecause of Instaliatwn <br />and maiNenance of ihe improvemeni or other nqhbol-way use herelo <br />applietl lor nnd lurlher a9rees to remove same unon notice hom Ihe <br />C�ty and to replace public pronerty dama9rd Iherehy. <br />� o �u-�. � Iy86 <br />Si�nature ol ApPlicant ���� <br />WORK AUTf10RIZED �Y THIS PERMIT MUST B[ STARTEO WIT4IIN <br />180 DAVS OF DA1E P[Rh11T IS ISSUED AND THEREAFTEIi IS TO <br />BE DILIGENtLV PURSUED TO COMPLETION. 7HIS PERMIT MAY BE <br />CANCELLED (3Y THE C�1� UPON ANV STOPPAGE OF WORK ON 7H15 <br />PROJECT OVER 90 DAVS DURATION <br />