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i y_. . . <br /> �� <br /> �� (' <br /> W � .�� /4 , n�roucwa,�nnn�mn ��-/2--. .. .. <br /> Uate� 1 ��d/7(p� <br /> Q ���nn o�w • <br /> Appbcntion �or <br /> ��� PllBLIC WORKS PERMIT ','S°`W""`'" s —_-- --- <br /> ,��,��.� <br /> FFF���]]] ,.�,�,� �..�•.,,, s� � <br /> R�� ,�.n,�� S <<" _—_ <br /> Print or Type Only Tn P�STING � �S �— 1—� <br /> ��� Ti�s� Trnrtn�� .t i.�l DI S?r� 0� 11JE Mz�usv,lle Q�¢p�;�Z)O Coi9~ ?s� �_ <br /> �� OWner Mad�nU AtldreSs C IY ��D PhonO <br /> C• <br /> �� �LTYytQ --� �— Z�p Phone <br /> qppli.:ant Mailin�Adtlrrss �'�Y <br /> �Fi /� I- LA <br /> �y(p Desc�lbe Pronosed Work NO��/ -���'1A-Lc--IOM�1�r�L�� � —�� <br /> d <br /> J <br /> �.� W <br /> Prolact Address I�t knnwnl �Z--��A���. � <br /> � <br /> Al�ach lour�4)copies o� P�ens�or Pmposed work� D�aw to scale and note Ihr,lollowing as apVhcable � <br /> • PropertY Lines • Cenlerhne ol sVee� <br /> • Oulhne nnd dimensions o� ell e.�slmy�nd � S dow q�y P�uposed 9rad�ng r,�anges <br /> proposetl siruclures on Ihe lot � Sliow measuremenls M <br /> � • EFist��9 enA proposed uliht�es W <br /> �. DO NO7 WRITF BLLOW 1HIS LINE O <br /> C� PEFMIT CONOITIONS � <br /> 1.All cells lo�inspection shell be made 24 hrs.in advance�phone 259•8810. <br /> 1 ' 2 All work 9hell be pedormed in eccordanco with�his permit end wnent Ciiy o�Everell Design end Construclion <br /> _ Stenderds end 5pecilications. � <br /> ��' 3.Call Localion Untlerground Service 40 hrs.belare you diq.TOLL FREE NUMBER 1•800•424•5555. <br /> I � <br /> O <br /> ( ��1 � <br /> � <br /> �1_� � <br /> - <br /> a <br /> _�_ � <br /> I ACKNOWLEUG[MENT OF CONDITIONS <br /> ����� � _ _ Tl�cundr�signedownrrlppphcanlheiebya9�ee5loholtlandSFvohmm- <br /> � — less Ihn C�ty ol Eve�e�l Irom any nnd all claims lor A�maqes. r.usts <br /> �����y- � erpenses. oi ceuses ol ar.tion Ihnt may an5e because ol msialla�ion <br /> ' �:/-". /:''` � �G,� anA mniNenance ol Ihe unPr�vement or other nyhPol�wnY use� herelo <br /> l.�f'� _ �Z� J ��'�L� pnf�lird lol and lur�hrv o9rees to r[!move sNmo Upon noliC,e hom Ihe <br /> Appro�ed Inr Consliucti ��te C 1 anJ to rrnlace public proPe�ty dama9Pd Ihereby. <br /> L L'/ �f <br /> !/ <br /> , — > l� '�1 �1 _ <br /> FlNAL INSPECTION �'��" Dale <br /> Approved as ConslruCleA Supti�tw�. � �I :ant <br /> WORN AUTHOfiITE� BV THIS P[RMIi MUST BE STAFTED WITHIN <br /> ����.��.�� PUdLICWORKSDEPARTMENT iq0 DAYS OF DATE PERMIT IS ISSUED AN� THEREAFTEF IS TO <br /> � 9200Cetlnr Slreet BE D�LIG[NTLV PURSULD TO COM^LETION. THIS PERMIT MAV BE <br /> EverelL WA 99P01 CANCCILEU BV THE CITV 11PON ANV STOPPAGE OF WORK ON 1HI5 <br /> Phone�?59-PB10 Pf70Jf CT OVCR 90 O�YS DURA710N <br /> I 1 . <br />