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Date—� ?��/ 7' �] (7 J(` I/� P�m�w��knPo�mn, `�' 1 �131 �— <br /> Application For I O f O J I I�1 V�S`��� "�� eiop oeoi.• %����_ _ <br /> PUBLIC WORKS PERMIT P°°°�w°�°FOe <br /> ,o���F�o s -- <br /> x[�-"�1 �essnooi Fe.v,ve 5 _ <br /> : ZD ` <br /> �"3 Print or Type Only o,�.,��oo�o __ <br /> [ f� _>�wc-�' ���.- . -j -- <br /> 9�3U <br /> r <br /> y `�� �'E� Of�- �'o c�r,ds�. �i3o ,v�,�R�c,c �uE:ccrr� i�'u.? �SiQ- s�Cd <br /> K ,�� � Owner Mailing:�tltlress City 2ip Phone <br /> O :O <br /> '-'1, ii'�J <br /> tnri J�; l 2 = <br /> � z r Applicant Mailing Atltlrr Cily Zip Phooe <br /> n o�i <br /> H C7 <br /> � n d Describe PropoSed Work �C�oa-��� �< /x-Gc✓ S«, _ <br /> H L=7 O <br /> G]� CC1, <br /> .'Z H 3 <br /> > H t7 <br /> rHy � <br /> g �, — — <br /> n d� Proiect Atldress 1�1 hnown) ��„�� - �-! �� SE� L <br /> q _. <br /> g [�� „�:.�r,n lour lal coPies of plans br ProPOsed wOrk� D�a.� I.:���_p�� .in.: �,,b•Inc lono'.vinq o5 aPPl�r.al.'�u. �� <br /> Zy� • Property LinCs • Ci�nti�rlin�ol sircct � <br /> �-3 O�� • Ou11inC�nd tlime0sian5 0l all u..st�.nq�n�l • IniLrrile No��O �' � � � <br /> propo5etl 5�ruclWeS un�hr I�I • S�•ow any nropos��:qrudiny cnan9es <br /> • Exisiing and pronoscd ubLhn�.: • Shpw inuasuremnr.!y iiQ�l°(,�$y' M <br /> � W <br /> DO fJOT 1Vf7iTE 6EL017 THIS LWE ""' "-' -' <br /> {'_�:fj e.,�.'�'��� O <br /> PERh11TCONDITIONS H-fH S', I_Q.�._��I <br /> t,qn eai�s tor insneciion,hau be made 24 hrs.�n adeanee-nbone 259•8810. .- q�,•�F; g: ,n � <br /> �� 2 All work shall be pedormed in accoi.iance with Ihi�p.:,nn�1 and r,wrent Gty o�Everev Desi9rq�diGonsVi �qn-,�, <br /> n,..w� �i.. . <br /> � ' S�andards antl Specd�c.tions. �u � <br /> �'"'� 3.Call Location UnderOround Service 4B hrs.betore you d�q.70LL FREE NUMBER 1•$00•4��Y�S�b05; , , � <br /> Ui`� .�0 :.':c.;,,���� <br /> 4_ Innt.al] ror.k conotruction enY.rnnce hehind dRt�Kewayn_iT,i <br /> �` � per cit:y nt:andard q208 to eliminaY.� Y.racki.ng nud onto � <br /> "`i nt:rectr� n❑ dir�ci:r.d by Pub.lic Worka Ir�s�cY.or. <br /> 5_ B��r.P ci.ty at:rnetrt cl.ean �t: all t.i.mea. <br /> '.e � B. Curb. �it.ter and nidewalk in t:ho plaY, are new and � <br /> .� E imd:unat;ed, �n)' dnmaqc; th�rFto nh�ll b� roplaced :�t; thr � <br /> die�r_rr_tion of the Pc.blic Workn Ine�cbo�. <br /> 7. Any ch�nr;n 3n tho drivew�y cut munY, h� lpproved by Lh� � <br /> i"' Pullir. Workn Inn��:tor. <br /> ""e' Ei- 'I'i�htline nll roof, yard and driveway drnins from � <br /> hoi�nFn t� ptihlic drainaqe �ynt:�m_ <br /> p. , 9. Ad,junt wai:er boxes to pradQ at end of r.onet;rucbion_ <br /> � � 70. Dri_vewa.yca �ha77 be comPletely curnd be.fore drivin�; on <br /> � I:h�m_ <br /> (� ACKNOWLEDGEMEN70F CONDI710NS <br /> �Y� 1he unticrsi9ned owner/apphcant hereUy n9�ces to hold and save h,unr <br /> � ! � Icss Ihe Cily ot [verel� Irom any anA all claims lor Aamaqe; cosls. <br /> expenses, or causes ol actlon Ihal may arise beC�use ol installntion <br /> ����/c./-- _ /� -Q _�I antl maintenance ol the improvemenl or olher nnhPubway usc h��rrin <br /> � 9��� �� �� ❑pplied br and ImUim agraes lo remove samc upnn nolicc Lom tnr <br /> � Approved lor Constni i� Dale <br /> S� 1� - City and lo mplace public properly Aamaged thereP.: <br /> � (i <br /> ���/�� /`"' //''=' �Q� <br /> FiNAL INSPECTION Datu <br /> ApP����d as Construc�ed Slynatm�[��+ pli nl Datc <br /> �-� PUBLICWORHSDEPARTMENT WORK AUTH0f71ZED BV THIS PERMIT MUST �E STARTED WITIIIN <br /> ��� 3200GedarStie��1 1E30 D�VS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> pN -' BE �ILIGGNTLY PURSUFD i0 COh1PLfTION. TNIS PERAUT MAY BE <br /> [vrcll.N'A9[3201 (1r1NC6LLLDE3Yl11FCIlYUI'OI:AtJA"::TOPPAG[Of-WORKON iHlti <br /> Phonc 259�9tJ10 PROJECI OVBR 90 UAl'S UIJR,UIOId <br />