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,�.,.. . ... <br /> i <br /> . ,... � <br /> �,. . � _. <br /> � <br /> K � <br /> -�=:I;,::. .. . . ., <br /> . �, <:j <br /> ym ca�+ C' f�`� �=���L �l�`� �q� _ /OS� / I <br /> tr; Date 5 �4' o��, Yvc>��� Z ��� CJ�1� v�ni��wo�wav��mn. _ il <br /> ► � em�� oeot� <br /> ��� Application For � ' � <br /> ��� PUBLIC WORKS PERMIT "°°°""°„"`.° <br /> To�a�FP� s <br /> � � TO POSTiNG�( �essnooiFecv;ue S � ,� _ I <br /> 8 9 z ��za— <br /> u Aalance Duc $ / <br /> O t�O Prinl or Type Only I <br /> '4 F�MI <br /> MO� _ ,` — <br /> ��CVF-2 C���> �� . i�`i 'ZC, l�f: ��Il:.c-,L���� ��� C-� CV I <br /> H Owner MailingAidress Ciry Zip Phone <br /> �pg -> > I <br /> H. o � �1 t-tivL c,l)�'tt�� �,�'C� 4-Ur\ r`ic- l�1aL�tA\\C-__�'z-�6 ._ � 5 y-6;r>�- <br /> �.'H Applicant Mailing Atldress Cny '�p Phone <br /> ! 1 <br /> H' \L �`�,�.,�1ti:E- �l\�'� � ��'-�,�1c;1.�� <br /> fA Descrlbe Proposed Work C`F-'�:' �� � <br /> M <br />' �� /�'�\ _ ���`�(���—�E-��'J . � ( �1L:C- T�L',. l+'t-�� � <br /> � �� W I, <br /> . _ 4 Proiect nddress fit knownl ? -- ����vG �J. c�UO�S' of C',�S��✓U � i <br /> i <br /> Atlach four(4)copies ol plans br proPosed work- Draw to scale and note the(ollowing as applicable: �� I <br /> • Prnperty Lines • Centerline ol street ♦^ � <br /> • Gu�line and dimensions of all existing and • �nAicate North V� � <br /> proposed s�ruC�ures on the lot O Show any proposed 9r;itling changes <br /> • Eaisting and proposed utilities • Show measurements q/� ' <br /> W <br /> - DO NOT WRITE BELOW THIS LINE O ' <br /> �� <br /> / � <br /> I � PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in ativance-phone 259•8810. � <br /> � �� � 2.All work shell be peAormed in accordance with ihis permit and current Ciry of Evereit Design and Construction <br /> 'f � i Slandards and Specitications. �. <br /> I 3.Call Location Under r�und Service 48 hrs.before you dig.TOLL FREE NUMBER 1$00•424•5555. � <br /> 9�7D ` y r� - � __ <br /> ' I 7�M <br /> . .� `N.� � _i ___ � <br /> I <br /> I <br /> I � �i�/� C�/� .S%���/� '� <br /> CL�.,N ,�� <ILL %i/r��J, � <br /> I °'�.� s/S <br /> c��� I r�1cR I_ <br /> ' � � V, <br /> ' p.,.,o �y ,` �p O <br /> � ..,.�.I p� _� ��, <br /> �.. � � <br /> —T---- � <br /> ��`�1 ---------�� _ _ - - � C' <br /> i --- � �u <br />