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��� <br />O <br />�y <br />9H� <br />H�� <br />M� � <br />� � � <br />yH <br />��� <br />OH <br />�/��g <br />y�Y C] <br />t+y� <br />hi H <br />�yH <br />C] t7 V� <br />r� <br />�O� <br />��, <br />Date�i����� TO POSTIN <br />qpplir�lion For <br />PUBLIC WORKS PERMIT <br />Piint or TyGe Only <br />��„�,�:,•,o,�-��•,m�� T��"j/S <br />.�/�.; L <br />bmo o�.W (y�.i7" J __ <br />Pueim wo�ts�ru $ ----__ <br />TOIJI iPfl <br />1059ACY� FCOF.lit1 S � '��- <br />o.i:���e o�o S . <br />�., — CitY Zi� Phon� <br />ApP�i�.���� Mailing Address <br />nl� ��-� <br />Describe Froposed Wo�k �y ._ <br />Fmlect Audiess (il Nnown) <br />A�tach four (4) copios u: Plans lor pioposed wc�k - Draw :o scale and no�e � Ceolerline of troet able: <br />. �.r�erty Lines • Indica�e Norih <br />• G.�:�me antl d.mensions of all ezisliny .��a � Show any propo5ed 9rauin9 changes <br />proposed strucWres on the'.ot � Show measurements <br />• Existing and proG^sed utildies <br />PERMIT COKDITIONS <br />7, All Calls 10- ins0ec�io� shatl be m:�de 24 hrs. in advance •[�hone 259•8815. <br />2. All work sh.,ll be pe��ormed'n accordance with �his pe�mil and currenl City ot Everel� Design and Consiruc�ion <br />Slandarda, and Specifical�ons. <br />3. Call Localion UnAer9round Serv �e 4B hrs. belore you di9. TOLL FREE NUMBER 1•800•424•5$5 . <br />�--- I�l �oo�� � � . n"7 <br />r,r u•ove : o�yCons�rtioy' M�. i � i`" <br />/ ///%%% ��— ,�/ i <br />��,,�� ii . ./^l,�.�—_. ������%/i/ <br />FINAL INSPECTION " Dale <br />qpproved as Cansiructed <br />everell PUBLIC VvOHKS DEPARTMFNT <br />� 3200 Cedar Street <br />Evere'I.'NA ."A701 <br />Phon¢ 259�FiF315 <br />ACKNOVJL[DGGM[Nf OF CONDITIONS <br />� <br />0 <br />r� <br />� <br />O <br />Th�; undeisigned owneri �PPlicant he�ebY ��9rces to hold and sa �e harm� <br />lu�„ the CitY �f F.veretl Irom anY ���� all cla�ms fo� damoges. cosis. <br />•.pensr,s, or causes oi aclion Ihal m�y criso ber„iuse ol installation <br />a��,d ma�nle ance ol Ihc unpio'�emenl or Other riyhl�of-w�Y use nerelo <br />ippli��d I r' nd lurih��r a� �s lo reroove same upon nu�ice Irom the <br />CtY �nd�o r�p��cr� bli pr perty d�ma9ed Ihereby. <br />I, ��� ' _ '- <br />��_; ; -�:. <br />, �-- <br />_— Da�., <br />Si na re ol Ppplicant <br />�OOAYSTOO DATE PEF�91T ISCISSUEU ANTD iHEF7EAFTEPV�SrTO <br />[[ DILIGEMLY PURSUED TO COM1IPL[TION. THIS aERM1T ht•�V BE <br />CANCELLED 6Y THE CITY UPON AN� STOPPAGE D�N'ORK ON THIS <br />f ROJECT OV[R 90 D��rS DURATION. <br />