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S�C 1 <br />Dete_12-�31 <br />Applicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Poeucwon�Pnnu _ <br />eauo.x. 9��35010 <br />we'� on�f�� _ <br />i... �om r.. v.a f <br />e.i.z.o�. 5 <br />R.R. PIERPE BOIB BEVE�LY HLVD EVERET'f 9B?03 353-2980 <br />OWner MalHnppEdrese City Zip Phone <br />OWNER <br />qpplicanl MaIIInOAtldrBss Clty Zlp P�cnB <br />Deecrine Pioposed Work SUNROOM ADDN _ <br />Prol�t AOErens 111 known� <br />AlieCh lour (4) Caplee oi phn6lof propo3aG work • Drew lo eCBle end nDte t�e �ollowlnB ee epplicaCla. <br />• PropertY ���ee • Cenlerline ol etreet <br />• Outlinn entl Eimen6lo�a of ell a�lellny entl • InEiceta Nort� <br />propoeed atrutturee on I�e lol • S�ow eny propoaed preEing c�an9es <br />• E�letinp e•�d proDoaaE ulllitlea • S�ow moeeuremanle <br />PERMIT CONDITIONS <br />t. All calla lor inapeclion ehell be mede ^•4 Lre. In edvance • vhone 259•8810. <br />2. All vrork e�ell be Dedarmad In ettorCance wit� Ihle permit end wrrant Ciry ol Evamlt Desipn end Conatmctlon <br />Stenderds end SDeclfiwllona <br />3. Call Lxatlan Underyround Servlce 4B hrn. beloro you dip. TOLL FPEE NUMBER �-800•424•5555. <br />/ ✓�' '✓-G �JUt �L Y''�.. .� ,: ;. ri �ay!tc::.�% <br />l <br />�a <br />�.s;;� <br />ApproveA lar Conelrucllon Da1e <br />ACNNOWLEpGEMENT OF CONOITIONS <br />Z <br />O <br />'�^ <br />�/ <br />O <br />a <br />The undereipneG ownerhppliwn� �ereby apmes lo hold and sava hern� <br />lefs Ibo Cliy OI EVBfBi� �f0111 111y et1E 011 Clairtl3 �Of EJ�IIBQ04 C06IR <br />eapensea or causes al ection t�et may arlee becaune ol In6tallallon <br />en0 malnlnnance ol l�e Improvement or olher �ighho4wey u6e �emlo <br />epp�led lor entl lurt�e� eproee lo ramove tame upon notica Inm t�e <br />Clly anC lo re0laca public prapar�y damaOeC the�eby. <br />fINAL INSPECTION Dale <br />ApproveE ee Conslmcted Slpnalure ol Aoo��cenl Dete <br />�PUBLICWORKSOEP/.RTMENT WORI( AUTHORIZEO BV THIS PEfiM1T MUST BE SiAFTEO WITHIN <br />9200GaEu91ree1 190 DAVS OF DATE PERMIT IS ISSUED RND TMER[AFTEP I$ i0 <br />Ererelt WA89R01 BE OILIGENTLY Pl1flSUED TO COMPLETION. TMIS PEHMIT M4V 6E <br />Pnone: PSB�BBiO CANCELLED BV TME CITV^ PO N^Nu STOPPAGE OF WORN ON TMIS J <br />