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x C'� <br />�T� r: <br />9 � <br />��x <br />C H <br />9 H Cn <br />y � ��-+ <br />�C C) <br />H x7 <br />"�{1 H .+] <br />C/� H <br />b7 O [�7 <br />H C7 <br />O H <br />H�g <br />fy] V � <br />� H� <br />h-� H <br />g`� <br />H <br />C] t7 f/� <br />� t� r <br />Z H f�/� <br />H O V� <br />Date � ���� <br />0 <br />Applicatian For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Mailing AtlAress Gty <br />a._-»., r._ - r.�,,.s i�� ��. . �/� )�� -7/ <br />nina O��ni � --Lv�y�y%l-KL— <br />Pueim Worb iee <br />To�nl Fee 5 <br />Less A00� Feo Pe�C S <br />Zlp <br />e,i,���� o�� <br />Describe Proposed Work � 1� �'7' X�� � �b7/�P ��'QG� ,y�-� SF <br />��s c � � u Iti(a,� S�;t�� � — — <br />Pro�ect Address lil knownl <br />Aitach lour �•:� copies o� p�ans for proposed work - Drav: to soiie anA note �he follo�ving as appLcable: <br />• Properry Lines • Centerline ol sireel <br />• Ou11me antl dimensions o::�il ea�s,�mq ;�nA • In�icote Norih <br />proposed struelures on Ihe �m • S�imv any pronosetl 9rad�nq chanqes <br />• Eris�inp and oropased WiLh��s • Show mrdsurements <br />Phonc <br />,w _ PERMIT CONDITIONS <br />t. All calls lor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />+! 2. All work shall be pedomed in accordance wilh Ihis permit and currenl Gty of Evemtt Oesign and Con,truction <br />Standards and Specilicalions. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�e s� <br />� � <br />-- <br />N o I�/�( ��-M � i `�-�= � <br />3 /z3 /��o <br />� � <br />� E-�; � ���_ <br />-�- c«� <br />ACKNOVJLEDGEh1ENT OI' CONDITIONS <br />Z <br />O <br />� <br />� <br />0 <br />a <br />The undersi{lned owner/applicanl he�eUy a9rees to hold and save harm- <br />Iess Ihe City ol Evcrclt Irom any and all claims lor tlamages, cosls. <br />expenses. or causes ol ar.tion that may anse Uecause ol installation <br />and maintennnr,c ol Ihe unpiovement or other righPol�way usc hereto <br />_ ;�pphed toi :�nd lunhci ugrecs to remove same upon nolice from U�e <br />APProvetl lor Consiruction Date l:dY :���� to icPlace pid�lic Pqip�!r�Y dnmageA Ihemby. <br />FINAL INSPECTION Dair <br />Approved as Consiructed Sig��,vwo of ,lpplicant pi��. <br />cvcrclt PUOLICWORKSDEPARTMENi �NOfiK AUiHORIZED BY THIS PERMIT IdUST BE STAR7ED WITHIN <br />0 32ooCedar51ree1 180 DAYS OF DATE �E(7MIT IS ISSUED AND 71iEREAFTER IS TO <br />EveretL NA 90201 �E DILIGENTLV PURSUED TO COMPLETION. iHIS PEFiMIT M11AV 8@ <br />CANCCLLLD 6V THC CRY UPON ANY STOPP1IGE OF WORK ON THIS <br />Phone�. 25&Gt3t0 pqp,7FCT OVCR ;30 DAYS DUH�TION. <br />