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Date��N �i <br />! <br />Applicatien For <br />PUBLIC W�ORKS �'ERMIY <br />Print or Type Only <br />.�?�,i� <br />�,., .,e, <br />�.��p <br />Appiicant <br />—1�- <br />Mailing Adtl;ess <br />Mailing Address <br />�;i�y <br />Zip <br />,,:�,,,�.",,.,�»,, f9-il� <br />��„�, o�.�, . _��r� �I��-'�� - _ <br />Pu�M1c YlorMs Fce � <br />TotTl Fe2 5 _- <br />Le55ApPl F>ePai� S <br />ti0lancaDuO 5 ���� _ <br />Phone <br />_l1 PuJ `—I ✓' <br />Describe Froposed Work ( ) /� . __ <br />�r✓D 1�JS%AGG NEc� 1�i2�(i�(.�{ �2 ���v — LEXiNGTdnI <br />Proiect Address Iif known) <br />�T N, kI. CO�I'. /V,�.f G:< <br />���2 — �.�X//liLr:,'.7.L'�f/t� <br />Attach four 141 copies ol plan��. for propose,d work - Draw to src,;� -. �� n;,i=_ ,�e followiny as applicable: <br />• Properfv Lines <br />• Ouiline and dimensions af all Czisfing and <br />proposed struclures on the lot <br />d Exislinq and proposed utildirs <br />�7 CP.�I2tIinC Of S�rCBI <br />4 Indicate Norih <br />• Shov+ any proposed gradir�g chanc�es <br />m Show measurr:ments <br />L N� <br />PERMIT CONDITIONS <br />1. All calls lur inspection shall be made 24 hrs. in aovaoco � phone 259$$1Q. <br />2. All work shall be performed in accordance with this pe; mit and r.mren! City of Everr:�e Dasiyn antl Construc!ion <br />Standards and Specifications. <br />3. Call Locatior. Undergrour.d Service� aR hrs. befor.� �ou dip TOLL FREE NUMBEfl 1-800•424-5555. <br />—. _ �.�—�,'=�� bZ'�-� / �% /L' <br />Aop��ved for Cons��. uct�on �- �Date <br />j f� � <br />_��'`' � ,_s� <br />FINAL IIJSPECTION ate <br />Approved as Constructed <br />e��errtt PUBLIC WURKS DEPARTMENT <br />� 3200 Cedar Strcet <br />Eveie�t. lNA 99207 <br />Phona 259�8810 <br />■7l <br />,1CK�dOW:EDG[MENT OF CQtaDIIIOIcS <br />I hc undersigned owner/applican� hereby ac��ees to �+olU and save harm- <br />less ihe City of [veretl Irom any ;.nd all claimc 'oi Jan,a.7es, costs. <br />expenses. or cawes of action that may arise because ol installaticn <br />and maintenance of the imprevement or other righbohway use hereto <br />applied lor and furiher agrees to remove same upon notice Iwm the <br />City and to eplace publi roperty damaged thereby. <br />/ <br />� � �-�-Q�L- <br />gig ature ol Applicant Datc <br />WORK AUTHORIZED F3Y TIiIS PERMIT MUST BE STARTED WITliIN <br />780 DAYS OF DATE PERM1IIT IS ISSUED AND THEPEAFTEq IS TO <br />�E DILIGENTLY PURSUED TO GONPIETION. THIS PERtdiT MAY P� <br />CANCELLED B1' THE GTY UPON ANY STOPPAGE OF WORK ON TH!5 <br />PHOJECT Ol'ER �0 DAYS DUHATION. <br />