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�,.�..� <br /> i: <br /> ��� ' <br /> 4 <br /> M �� Date—i_�,���CS � . . <br /> r�n���.wo,x•ro,m . ¢.�� <br /> � n Apolicalion For nmu oept ._ <br /> ��° PUBLIC WORKS PERMIT r �tonfea��� . ---- <br /> � � lnu�UPI fe�PeiE f <br /> �.qj. � Print or fype Only n.�.��.o�� 5� <br /> ��g <br /> "11..��" " ��1�r�'��Id - � i��r��-► +����nc��l� �� Q a �:� ����� �f� �� <br /> yy ,s�— <br /> :�y Owner Mplling Address City\ Zin Phon? <br /> F <br /> ���yy�H (.1�1� � <br /> �y Apphcxnl MaiLng AAtlress �i� '— — <br /> � �+ Y ZiP Phona <br /> yO VJ Descnbe Proposed Wo�k l -����A , � � �� L �� ' � �.�'�'�1 — <br /> H <br /> Prolecl Atldress lil known) ���� � ; <br /> Attach lour(4�copies ol plans�or proposed work�Draw to scale anA nole Ih�lollowing es npP�iwble: � �, <br /> • Properly Lines • Centerline of streel � � <br /> • Outline and aimensions ol all esislmg nntl • Intlicnle Norlh ' <br /> propOsed SlruCtures on Ihe lot • Shpw pny proposed yradmg changns <br /> • EMls�ing end proposed ulili�ies • Show measmemenis <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls�or Inapectlon shell be matle 24 hrs.in ativence�phone 259•8810. � <br /> ���i 2.All work shell be pedormed in nc[ordance with this permit und currenllGty ol Evorery Design anA ConstmUion <br /> � Stenderds end SpeCilicnli0ns. <br /> � 3.Call locatlon Underground Service 4B hrs.bebre you di�.TOLL FREE NUMBER 1-800•424•55:i5. � <br /> ��i / / , / <br /> `�. �.�.� ��,ti- c d , .�Ti�s r�,•:�`r'_ c� �J_� c? - t� E`• O <br /> '� /= , <br /> i <br /> I � <br /> !_I—i � <br /> � <br /> a <br /> � t�—i <br /> nCNN��NI.CUGCAIENT Of CON[]ITIONS <br /> The witlei5i9ncA ownrri;ipplir,nt herehy xgroes�o hnt��ntl save harnr <br /> / . less Ihe City ol [vrre�t limm �ny and nll daims lor Anmaqes. cosls <br /> �� ��� /' / � eMpense5 or cause5 0l a[Lon Ih�i may an5e because ol inslalla�ion <br /> �-�)� � � e �7 — ��� AnA mamlenan�e o� �he imp�ovem�nl or olher ri���'ol�wuy uso hereto <br /> � —' apphed lor nnd lurther nc rces lo remore same upon nohce Irom Ihr <br /> Approvetl lor Co��iuclion " Date Cdy and to replace public' roperty damagetl ihereby <br /> / - y� B "'/ <br /> FI L INSPECTION p��� � "'-y� _ <br /> AnP�ovetl as Constructed �� - �—°u °� <br /> Siqnnlure ol phcanl p��i�, <br /> rvrrrU PUBLIC WORKSDEPAqTMFNT WORH AUTHORIZ[D BY Tl115 PFRMIi MUSi OF STARTF'D WITHIN <br /> � 3200CeAerStmel 1(i0 DAVS OF DATF P[RMIi IS ISSUGD ANU iHEPEAFTER IS TO <br /> EvercO WA99.U1 E�[ DILIGCNTLI' PURSUC.D TO Cqh1PLETION 7NI5 PEHMIT IdAV Oi <br /> Phone 259-9A10 C�NCELLCU �Y THf_CIiV UFON ANV STOPPAGC OF 1VOIiY.ON TH�S <br /> FlROJ[CT OVf.H JO DAYS DIIf7ATION <br />