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� i <br /> � 8q-y� <br /> Dete� r�m�o woa.a.. <br /> e� ow� • - <br /> � Applkr.tlon For <br /> PUBLIC WORKS P�RMlT °�°�:°F:°M : <br /> i U���oG�FN PbE s� . <br /> e�I�nu oue s <br /> � Print or Type Only <br /> �h���nn rrr�e�.� ��� �.�a� St. �u� #l�g ��r�n�9� <br /> y OwMr Ma1Nnq Acdress City ZiD Phone <br /> ' ����I <br /> I ����� Mellinp Addrese City Zip Phone <br /> 1 <br /> DeseNOe Propored Work C� <br /> t <br /> � <br /> : S� � <br /> qpMet Addnu(tl known) "" <br /> Atl�ch lour(q eopMs o1 Pl�ns for proposed work•Drew to ec�le s�d noie Ne tollowinp e�apoluble: � <br /> Y ;�' •Prop�rty Lln�s •Cantedlna of�tnat <br /> � •OuNlns�nd dim�nNona of dl exisling entl • Indic�ta North <br /> :� prppoNd�iructurN On the lol • Show�nY propaW pradi�q eh�np�� �� <br /> !:'` •EaiHinp�nd vroP«�d uniitbe 11 Show m�uurom�nt� 'i <br /> 1 L LN <br /> ` rNIMR COND1710N8 � <br /> t.All aM fa MwP�WaN b�nrd�2�hn.In adv�na-Phons 46Y�el11 Q <br /> }. <br /> 2 AM wak NrM b�P��d In aaord�nw wNh MM P�R�nd euReM CHy W Ewrott Ds�q��nd Cominaflon <br /> S GII Laptbn��rvbs AB hrt.Defa�Y�dW,TOLL RIIlE NUM/t111-e0O444�E�b. <br /> ;�, � � �/ ,�� twa.� .�..�. �.t�i/v �� �, �.;�. <br /> T, C�isa.�� .�'c Dceu, !'on�sl' ' �cvtue�.y GcoQ � <br /> �,,,�. �� . . C� �. �..9,���d,.- �� �',' <br /> ��.�..�. �.. � . <br /> �, <br /> ;,: <br /> , <br /> 1 ACKNOWL'cDdEMENT OF CONDITIONS . <br /> The untlersiqned owner/�DP��unt hersby pross to hold�nd wve hum- <br /> 1— lesa the City of Everelt trom any a�d dl cl�ims lor d�muQ�4 coria ; <br /> expanass, or causea ot actlon that m�y arlae becau�e of inatallatlon <br /> � � „ e and malntenence of the improvement or other Apht-of•vny use�eroto <br /> � gL• epplled for end further e9rees lo removs wms upon notice irom the , <br /> Approv r omtruct e�e City end to replece public vropartY d�m�qed thersby. �� � <br /> � Dete � " ' ' �� �� <br /> F�Ap rowd�s Con�ructed Slpnaturo ot AppllcaM �° � <br /> � WORK AUTHORRED BV THIS PERMIT MU9T BE 9TARTED WITHIN ��� <br /> � � pUpLICWORit80EPARTMENT 180 DAYS OF DATE FERMIT IS ISSUED AND TMEPEAFTER IS TO <br /> 3700CWuffinN BE DILIOENTLY PURSUED TO COMPLE!ION.THIS PERMIT MAY BE I <br /> EvKMR���� CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS ; <br /> ' Phona:259-ES10 PROJECT OVER 90 DAY3 DURATION. <br /> i. <br /> . �",'� <br />