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� <br /> � 6'6-3ss <br /> o.o„�wa,�-e.,m,�f�� / 922 — <br /> �BtQ � Bi�p Deo� • <br /> qpplicatfon For �-- <br /> PUBUC WORKS PERMIT Puoucwo�x�iee �_ <br /> Tol�l Fae <br /> leu�oC�Fas Pod � n =p <br /> . B�imcaDea = 's� <br /> Prfnt or Type O Iq y <br /> \ City Zip honx <br /> Owner '\ Melling Addresn <br /> �/ ..CitY ZP P�00e_� <br /> ApP��B�� Melling Address <br /> DBferlbe Proposed Work n,/ � <br /> � <br /> ✓ <br /> - y9 �o - c�,,�vao,�- �c' - �,,�i <br /> Pro�ect Addreae(II known) � <br /> Attaeh lour(4)coples ol D�g�'�a for proposed work•Draw to scale end note�CenteWine ol etpeel � � <br /> • Property Llnen • Indicate North � <br /> � Outline end dimensions ol ell eKisting ond � Show eny propos � 1 <br /> prOpOned siructuree on Ihe lol � Show meesure r j <br /> • HKletlnp end propoeed utilitfee � /V <br /> DO NOT WRITE BELOW THIS LINE / ��� <br /> I%iL. <br /> PERMIT CONDITIONS V <br /> 1. All cells lor Inapectlon ehell be made 24 hrs. In advance- p hone 2 • 8 1 5. � <br /> 2. All work ahell be pertarmed in eccordence with thls parmit and curre Iry ol E <br /> Slendarde end Speriflcatione <br /> 3. Call Locatlon Undergrnund Sarvice 48 hrs.belore you dig.TOLL F EE N MBE ` <br /> ,� jNsr�t.. 5�,.�J O.v n7.9,� r.3ox -9T 9�c ss l,t'i✓E' O <br /> T S//ou1 qno.�'ss �Zit E.•,e)eGEnicy �' ✓icGS � <br /> ✓�. ��l/STi�cG L'D,t/CRFTE" CUt JE�Y ����D✓./� A � <br /> �,e�F�ay �.r,�,�ti�E. <br /> 6 ��yyD�A�T �.. Gr�' d,�v� jl BE G�iARDEO DisCvssE� O <br /> ��D s�ow,r/ o,s/ P[oT q,�/ Fo�e �/ousE Ta B Ca.dsr,eu�rFo A <br /> ii <br /> � T.YE E�os7� <br /> K E�SEM•E.�/� TO C.eOtt A �'v��` <br /> 7 /�RO✓/OE ZL�C QIXUME FR EASEmE��� QQil�•t1 C/ E <br /> ���������� Wf- SiDE � ��l �� ' ACKNOWLEDGEMENT F CONDITIONS <br /> Thr undersigned owner/applicant hereb eprees to hold end seve herm• <br /> -- leau lhe City o1 Everelt Irom eny end 1 clalms lor demages, costs, <br /> eRpensas, or ceuses ol actlon Ihet mey rise beceuse ol Inctailatlon <br /> � p oy �6 and melntenence of the improvemenl or o er right�ol�wey use ha�eto <br /> � epplied lor end lurther ag�eea to remove me upon notice Irom the <br /> Approved for C truction Data Clry end lace public � rty demage thereby. <br /> i <br /> FINAL INSPECtION Dale , Date <br /> Slgnetur nl Applicanl <br /> Approved es Conetructed WOR UTHORIZED TH PERMIT MUST 8E STARTED WITHIN <br /> er:�ett PUBLIC WORK DEPARTMENT 180 DAYS OF DATE PEfiMiT IS ISSUED AND THEREAFTER IS TO <br /> � 1200 Ceder eet !�E UILIGENTLY PURSUED TO COMPLETION.THIS PERMIi MAV BE <br /> cverelt,W 8201 C4NCEI.LED BV THE CI1Y UPON ANY STOPPAGE OF WORK ON THIS <br /> pt�qne:2 •8915 PNOJECT OVER 90 DAYS DURATION. <br />