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M- 2i-29-s y� / <br /> Dete�� we�won.r.,m«. <br /> ApPlicetlon F x ea�ow�• � <br /> PUBLIC WORKS PERMIT ^�°;o:;:`� . <br /> iro 000�re�v�m i <br /> e.i..�.o�. { �L' <br /> Print or Type Only T� pnfTl AIG ,S-S-r/j <br /> �la o73�/ 7vdP J'f �✓e�rtf 9�'20 � ds�`-.3E�/ <br /> Owner Malling AOCress City Zip Phone <br /> ApP�icanl Meiling AtlEreSs Cily 2ip P�one <br /> Or�cribePwposedWork ��/,F __Li!A'�/ �/���✓ ��L .— — <br /> _ / <br /> _ / W■ <br /> Praleci ACdre551i1 FnJwn) 3z�p � .l� � <br /> Allach lour(4�copies ol plans lor proposed work�Oraw to scale antl nate'�e lollowing as applica0le: � <br /> •Propetly Lines •Centedine ol slreel /w <br /> •Outlinu entl tlimnnsions ol all eaiStinB antl •Intlicate Norl� V� <br /> propo�ed stmctures on Ihe lof •Show any proposed grading c�an�es <br /> •Ezislinp entl proposed utililies •S�ow mea5uremenl5 � <br /> DO NOT WRITE BELOW TMIS LINE O I <br /> 1'ERMIT CON�ITIONS <br /> t An cans lor inspection shen be mede 24 hrs.�n ativence•pnone 259•8810. � I <br /> 2.All work shall 6e pedormed In eccortlance with Ihis permi�entl Currenl Ciry ol Everelt Design end Constmction I <br /> StendarEs nntl Specilications. ' <br /> 3.Call Locelion UnderBmunA Service 4B hrs.belore you Uig.TOLL FREE NUMBEH 1•800424•5555. � <br /> O <br /> � <br /> N <br /> O <br /> a <br /> n\� ACKNOWLEDGGMENT OF CONDITIONS <br /> The unders�gnaE owner/applicenl�ereby ag�ees to holE en0 save harm� <br /> less Ihe Cily ol Evemil Irom any anC nn Uaims lor Gamapes cosls. <br /> OapenSeG 0�causes ol OLlion Ihal may an5e beWuse 01 Inst211alion <br /> ',�A�(� ��10_[�I antl maiN�nancc ol Ihe imorovemenl or otber rigM�ohway use nercto <br /> /Pl ✓V1 l�(� epplietl lor nnd turihm aB�ees to remova samrt uoon imtice Irom Ine <br /> Approved lor C stm/cy/y n Date Cily anC�o replace pu0lic property damapeA Ihereby. <br /> �F%"s—. y� '3d.��! � f - � ( Z <br /> FINAL INSPECTION D9te - <br /> APP��vetl ne Conslrocled Signature ol Applicanl �a�. <br /> � PUBLIC WORKSDEPARTNENT WORK AUINORIZED B -TMIS PERMIT MUST BE STAflTED W'h�.N <br /> tPOJCetlnrSlraet 1B0 DAVS OF DATE PERMIT IS ISSUEC l�ND THEREAFTER IS TO <br /> Eve�eq WA9BYOi BF DIUGENTLV PURSUED TO COMPLETNN.THIS PERMIT MA�BE <br /> Pnona.25'Jd�810 CANCELLED 8V iNE GTV UPON ANY STOPPPGE OF WOFI:ON TIIIS <br /> Ff70JECT OVER 90 DAYS DURATION <br />