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onle_lC/=-��"�� .. �l! � '1 .�S <br /> � ; � , . � , , / <br /> qppl7caLon F or / <br /> �ny PUBLIC WORKS PERMIT °°°.o�aF'e�`°° $ - <br /> �y �es�nooi iee Fina 5 <br /> �'�� ee�ance oue $ <br /> C H —_ <br /> a'��' Print or Type Only <br /> C �. <br /> yzH / /' <br /> O x0 �/ fY/ .O _7feo��- IJ/)IrNA7 �✓C//� �����PS --__ <br /> "� y H �Ownser_ Madmg AtltlfCs�' C��Y Zip Phonc <br /> y C <br /> � �C7 — APP���y�� MailingAtldress Cily Zin Phone <br /> O H <br /> � �g � � � � � - �,�1��/T-- <br /> �� n Doscnbc Ptoposed Work / "� n V a1--�� � <br /> H <br /> aN . - <br /> r z - <br /> g "'� - W <br /> N <br /> H <br /> �nd�j� �7 �� ,.] [.� � /l�—�� �/ /�7I.,�./ <br /> L"r P,cP.c�Adtlres�0� knownl ']�'�'-�-��'-'-{-G-/1�d " _ _ _ -- - _ _ � <br /> ZH� �� <br /> y p V) ,,�,�� �• `��.�,n 14)copies o�p�ans lo�p�oposetl wort� D��w tn sc�d��ar�tl no�e v+n�ouowing as app��cib�o <br /> • Properry Lmes • C��n��,dme ol stree, � <br /> • Outline and Aimensi0n9 0l aIl o�uln'.q ;n�A • Ind���dle Norih <br /> propos�,d sinielur05 on Ihe lot • Sher� �n)'P�oPosetl�t�.i�1:��,�1 �:�'�:�''.I�", <br /> f Eri;'���q anA proPoSeA uldAios • Show ni�,,�tiwemeNs' � <br /> '�'��� DO NOT VIRITF �ELO�"J �HIS LINH <br /> „r P[F7641T CONDITiOWS � <br /> � �1 � <br /> 1,All cai15�or insperlron;hall be made 24 hr5.i.t 0dvnnce�phOnC Z�J9-88 . <br /> "n+► 2.�II v:ork shall be pudormed m aceo�danto wdh ihis peimit nnd cunent Cdy ol Eer�en D��s��tn nnd Construct�on <br /> Slantlards end SpealicaLons. <br /> 3.Call Locolion Underground Servi[e 40 hrs.belore you d�q TOLL PREE NUMOER 1-800�424•5555. � <br /> �` �� . � <br /> �.3 � �!�.f•((.fN/f�-�V�M•t,( �K��/�P¢Cynl�:t <br /> t' <br /> � � ����� � <br /> : �� ' / ,�/ M/�/ <br /> .. � V^ <br /> � ,v. ..:� 6i <br /> � '' ACI(NOWL[�GEMENT CF CONUITIn�J:9 <br /> The undersigned owner/applican�hereby agrees lo huid and,avc hai nr <br /> — --- Iess ihe Cily of Everell Irom any and all claims Ie� dnmages, cor�.L�. <br /> � expenses, or causes ol action that may arise because ol installa�ion <br /> � and mainlenanee of the improvemenl or other righl-ol�way use herelo <br /> applieA br and lurther agrees to remove same upon notice irom !h�� <br /> pi�,;;� ,,��,i loi Consiruction Date Cily and to�eplace public property damacJeO�hereby. <br /> IIIJAL IrJSP[CTION D'ate Daie <br /> arpiu�rJ:is Cons�mc'ed Si9nnlum ol Appllcanl <br /> WORK AUTHORI2ED BY THIS PERAIIT MUST BE STARTED WITHIN <br /> � � PUBLICJJORKSDEPARTMLNT 180 DAYS OF DAiE PERMIT �S Iti Uf�-0 �ND iHCqEqFTER I � TO <br /> � 3200 Cetlar Slreet BE DILIGENTLV PURSUED TO CO��� I C110N-THI P[RI.11T 11AY !iC <br /> � [vcreil b1A�t3,01 (:ANC[l LLD PV THE CITV UFOY � J ' :10PIb l L r�FVi(�Rk ON 1111� <br /> 1'���-.. . . . I l�I�n.q �J UVI I; �.�(: f�,��51'lil;111i).J <br /> L <br />