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.� <br /> 7�� -�n"�y� C�.p��.:�Va�hs Parm�t• _�� Z�� <br /> Date�v��`� - --- __ <br /> e�-W oem • <br /> qpplication For _ <br /> PUBLIC WORKS PERMIT '"°'roWF��`°° 5 <br /> �e„aoo� .�P�a„ s � <br /> y�� oaianceo�e g 'a'0' <br /> ��ay Prin�TypeOnly <br /> � /� t702-3225�0//83/ <br /> ,ox�x �RCK�C SFi-�:� 3:3,� 3 / U ��./� f7J� �,! '78ao/ �� - 9�h�� <br /> a y� �1 , I.�' e,�fi�i-�o-3�5�.=-C-z-O�c"3 <br /> H �� � T7 oc3 [.7[n lC.i <br /> Mailin Address U Cdy Zip Phone <br /> H H Owner 9 <br /> � y� ` 3-���--3333- <br /> o m o /��� , /_ � '�r-�' m ,�-4k-1.o <br /> y N ti �Applicanl r� Maiiin�AtlAress ��Y Z P Phonc <br /> Z <br /> GHt7 �✓�JCwCLG���2L��`_�� /�e. C�� V <br /> Describe Proposed Werk �-- <br /> � �8 <br /> �1]Y �] <br /> a y� — W <br /> g �y .,�a3 Tr. / a - �n ��lere_?7 �, tn 9P>c� l � <br /> �.y PmieG Atldress(ii known) - <br /> C� C� � <br /> G q� quaci�lour I41 cop�es ol plans Io�proposed work- Draw to scaie and note tne fonowing as apphwbir. � <br /> � �� • Property L�nes • Centedine ol street <br /> X y y • Outlme and dime�s�ons of all existin9 antl • Indicale Nor�h <br /> H O� proposed StrucWres on the lot • Show a�y PropoSed 9ratlin9 changes <br /> • Enisting and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls lor inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be pedormed in accordance with lhis permit and curreN City ot Everell Oesi9n and Construclion <br /> �, ,� Standards end SpeciGwtions. � <br /> 1 y � 3.Call Location Underground Service 4B hrs.belore you dig.TOLL FREE NIJMBER 1•800•424•5555. <br /> �- �i f� �c� �, i�p z4.;�, �.�°!G � c.�.� ���� � <br /> � . ���.�-y .�-�� ��.e. ��„Y....,�. w�n.�,. F_ <br /> ,--- .�� N <br /> y � INITIAL INSPECTION O <br /> ( ,I � KIFiK BROOKS a <br /> - _ . . - > _ <br /> `^ n' DATE <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �( 7he unders�gnetl owner/appGtant hereby a9mes to hold and save harm� <br /> ` '� �y�'V ---- less the Cny ot Everetl Irom any and all Gaims lor damages. costs. <br /> i.�� I eRpenses or causes ol aciion t�at may arise Uewuse ol installatio�� <br /> �/��� 7�_/�Z antl inaintenance of the Imprm� other right�of�way use hereto <br /> (��� �/ <br /> ap Letl '�nd �urlh� ree to remove c upon notite irom the <br /> . . � - ApP«�ed lor Construc on � a�� ity and � �a ° u I c p erry�ama ed �er��y�_l�� <br /> / J <br /> I � � ' - '' n <br /> f" '�!` l( �IT+ / � `� �i � � <br /> Date "� <br /> PINAL iNSPECTION SignaWre ol App icant D�te <br /> �nnroved as Consiructed <br /> WORK AUTHORIZED BV THIS PERMIT MUST B[ STARTED W� <br /> �� PUBLICWORHSDEPARTMENT 180 DAYS OF DATE <<RMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 CeJar Sirecl GE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY B[ <br /> [vcret6 Wn3B201 CANCELL[I7 �Y TH[GITY L1PON ANY S70PPAGE OF ll'ORK ON THIS <br /> PP.one�.2548810 � PROJF_Cl OVEH 90 DAYS�UR,1710N. <br />