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� ..- . <br /> ;: <br /> ��Z// <br /> � ���,�..,�o,.s��,�� ,,�,_I-� s.. <br /> �i Date_�=���� Aiae o�w . �J_/`C � � <br /> qpplication For _tL�a__ <br /> PUBLIG �lUORKS PERMIT °"°���wFeC`°` s �'' ` <br /> , <br /> LvssAOol Fee Pm� S 7��d�— <br /> (� 7' (�� p 3S l <br /> ��'��1 Print or Type Only <br /> _^ �`.1SI��V��g-� lJ� o:i,,,��o�� S <br /> 4+''C�..� �-�' /�-,/ ,n t� U 1 �+�. ,�J� (�/� r'1 �1 ''� <br /> 9Htn I( 1�!"ll`1 / L .y�� �l'� IC/���� � ��� II �.��i-_i fJ 1 / / <br /> H � —'+—� � � Mailing Address C��y ZiP J Phone <br /> � Owner <br /> y H <br /> � H.�ro N. I�l. <br /> ���Y Z�p Phone <br /> 'b y H APPIicaN Aladin9 AAAress <br /> � �� 1'1Pa t Zc2�►=��� - — <br /> Descrihe PropoSetl Wark <br /> ON <br /> H �g <br /> �� � - W <br /> ry� �-72-7 EASTMA+C�tJC ViE�.I i7� � <br /> H H Project Address lif knownl <br /> �(� y � <br /> ~ Attach four(4)copies ol plans lor proposed wo�k� Draw to 5calt� and note Ihe lollowing as appl�cable: � <br /> rJ p1 • Cenledme ol stre�� <br /> C, G'� • Property lines � Indicaic Plorth � <br /> 3 t+'J • OWline and dimensions ol aU e.iseng antl <br /> � � Shcv:any ��roposeA 9rading chan9es <br /> x y y proposed sirur,tures on the lot � S�'�ow measuremeNs M <br /> H O V� • Ealsling a�d proPosed utilnics W <br /> DO NOT WHITE BELO�V THIS L�NE O <br /> PERMIT CONDITIONS � . <br /> 1.All calls for inspectior shall be�::ade 24 hrs.In advance-phonr.259•8810. <br /> 2.All work shall be pedarmed ir.acco�dance wilh Ihis Fermit anA curronl City ot [c��n".�Dosi9n and ConstrucLon <br /> Stantlards and SpecJication�. � <br /> �. 3.Call Location Under9mund:iervice 4B hrs.belore you dig TOLL FREE NU7M�R�8�•424•5555. <br /> ' � f� ��1/��/����/ �s ��/�'� 7 �— O , <br /> R�� � <br /> r! <br /> � <br /> '� O <br /> � �...� �. <br /> - <br /> I' <br /> `— qChNOWLEDGLGIENT OF CONDITIONS <br /> The undo�s�pned ownedopplicant hereby a9rees to hold and save harm- <br /> less the Cdy ol Everelt Irom any and all claims for doma9a5, cosls. <br /> f � ' ^—µ==�- � eX{�en5e5. or Causes o� .lC�ion Iha� f11dY �fi5e bec.lu5e o� in51Bl181i0n <br /> and m.m�enance ol lhe improvement or o�her ri�M�obway use hereto <br /> +— ���.. / ApPPed lor and lurther a9rees to remove same upon notice Irom Ihe <br /> Appwved�lor Con j clio Date C�ty and to replacu PuUlic propert dama9ed thereby. <br /> � <br /> ,, , !. f!� — �j J �— ��_ <br /> o,�� .o�� o,i� <br /> FINAL INSPECTION �. .�Signalure ol Applicani / <br /> qpproeed as Consiructed WORK AUTHORR[D BY THIS PEFMIT MUST 6E STARTED WITHIN <br /> 0 eveiett PUBLICWORKSDEPARTMENT 180 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 68 <br /> Everclt.VlA98201 CANCELLED BY TI1E CIiY UPON ANV STOPPAGE OP WORK Ori THIS <br /> Phone.'s59���10 PFOJFCT OV[R 90 DAYS DURATION. <br />