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Date���� �,,..�. u�.�, .�,�U � y�. 1..p- - <br /> ApUllwlion Foi �� ----- <br /> WORKS PERMIT °°°"`w°'"'"` S <br /> PU B U C '°'.11eB <br /> �ess noo�reo va�n 5 <br /> eoiance mc 5 <br /> Print ar Type Only <br /> � �� � <br /> � L03 � 5��- �-�/3 G <br /> > H �L�/LN�cE .C�f:LL 75'J `� C,�O/'E-•C �N/oGt'�.0 l�zn Phone <br /> �p �x Owner ldailing AdAress <br /> 9HlHi� Z ` 3J'Y—USSY___ <br /> t� T 5�Y3/ .UL`CJRu,�G/—'O .S•f/l,�aini,IN SS �O <br /> N � 3 /E/) V 2/S A S C�v Zip Nhone <br /> H � FI APPlican� Mo�lin9.+tldi�ss <br /> K n <br /> H xl <br /> "�9 H� n-o S"a,c � /> >/T/a ,J _ <br /> � H Desaibe Proposetl Work e� y <br /> Hx <br /> py � � <br /> H � g �... <br /> �• q� ��ay �- PPe`2 �ioe� ,ed —— <br /> xy H 3 Prolect Address lil knownl <br /> t� yx <br /> q��,�h lour(4)cooics ol plans lor p�opesed wo�h�Di�w ic scale nntl note ihe follo��in9 Fls ap��icable � <br /> H H • Property Lines • CentedinA ii street <br /> � y i Ind'�cale North <br /> H • Ou1Gne and tlimen5iona o�all eai51mc1.�nd � S��ow�ny propo'se�1 9r.�linq Changcs <br /> n ty y proposed slrucW res on the lot � �hav+measuremcn!s M <br /> �C � • Exishng antl proposed utilities W <br /> L+7 <br /> n0 NOT WRITE F3ELOW THIS LWE O <br /> .x-� o c�'n <br /> �i� PERMIT CONDITIONS ^ <br /> 1.All calls lor inspection shall Ue made 24 hrs.in advancc�phone 259•8810. <br /> 2.All work shall be pedormed in accordance with this permit and curreni Gay ai Ecerett Desi9n and Construction � <br /> Standards and Specilications. � <br /> � 3.Call Localion Undarground Service dB hrs.belore you dig.TOLL FREE NU�dBER 1•800-424•55 . <br /> � � 1 O <br /> ��� \ Wo�cl�C ��2�c,a-• � T �c:i ��CLiJ «��'� <br /> �—{�l�u c_ L <br /> r— <br /> e — <br /> � <br /> i -- �f� ���1���� <br /> ����, �,�� c�- — O <br /> wl i � <br /> '�� <br /> �� f�CKNObVL��G[G1EN1 OF CONDITIONS <br /> � Thc unde��iyi�ed o�vner/appl¢an(hereby agreesto hold anJ sovc hnim- <br /> _ --�—'--'--�—� L,ss Ihe GIY ol Eveietl imm any and all claims lor damayes. cost_. <br /> '=t_1 �.�wpen;es, or causes o1 aclion ihat may arise 6ewuse of install;�t.o�� <br /> ;ind inaiNenance of ihe improvement or oiher nghbof�w�y use hcie�o <br /> applieA tOr antl �ur�her agrees b remove same upon notice ��o�» >��" <br /> - � � qpprovcA lor Consiruction Dale City and to replace puhlic p�operty damaged Ihereby. <br /> FINAL INSPECTION Date Da1c <br /> $ic,7nature ol Applicanl <br /> �nn�oved as Conslrucled <br /> WOFK AUTHOPIZED BV THIS PERMIT MUST BE STAFTED WITiI <br /> i�,���.�� PUBLICWORNSDEPARTMEN7 180 DAYS OF DATE PE(iMIT IS ISSUED AND THEREAFi[R IS TO <br /> 0 3200CedarStreet BE DILIGENTLY PURSUED TO COMPL[TION. iHIS PEF7�.117 1,1M E7G <br /> Hveret6l"JA 98201 G�NCELLGD BV THE CITV UPON AN1'STOPPAGC OF WOf�K ON �Hiti <br /> Phan¢253�6010 PROJF.CT OVL-ii�� ���5 DURATION. <br />