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� <br /> �Date_ "�-�} I F„��,<<•:o,�;Pe,m,:. -3 Z7't�'�' _ <br /> emo oep� . <br /> qppiicalion For <br /> PUBLIC WORKS PERMIT PueicYlodsFee S <br /> H Tolal Fee <br /> C�� Lesf Appl FCe Pa�p 5 (�� <br /> ��� �� <br /> 9y T p T 1 BnianceDue 5 <br /> >Ht~i� PrintorTyPeOnly I� 1"�Sl �1'�G. _._._--�--� �� <br /> rx <br /> H a� <br /> y zH <br /> k � <br /> O x0 O:v�ir PdaihnqAatlress Gr, Zip Phone <br /> 'sJH'i � '_ _ . _ <br /> d % � �,::� ' ✓_ � n� � � ' - % ' ! Z� <br /> H �C�' /"��C �� r � Oo k�L >•��� p :,� L�'. / ) p � �S � _ <br /> � z� Pdailin Address City Zip Phone <br /> O LT1 APPlicant 9 <br /> HG <br /> x � ��S-Fti�1 � �c � ��S �fi Gc--���ct �-c �x�� ��, <br /> H ['+i� Descrlbe Proposed Wo�k �-r � <br /> H" � �1L+c ,.��_�� �� _ <br /> zH� � <br /> �3 <br /> H H --- � <br /> N <br /> H — � <br /> c� t7 cn �`Z; I 3 — �"� 1�� <br /> C C� Pwjecl Atldres5ld knovin� -------- — <br /> 3, C�1 <br /> Fltar,h four I41 copies nl plans lo�P�oposed work- D�av:ir� :.r.dc .�� •� �r�ovowing as apP��c�Cie � <br /> '�-� ti N p Cenierline of sir^et � <br /> y p f/� • Propeny Lines <br /> Y OulHne and dimensions o� ��� �••;�,;�nq anA • Indicate North <br /> proposed strucWres on ihe Ioi • Show any propOseN grad�n9 changes <br /> • Existinc ;md proposed utileies • S��o:� med5wemen'� /�A <br /> W <br /> �� DO 'JOi VJEiITE�ELOVJ TNIS LINE <br /> PERMIT CONDITIONS O <br /> � i.All c311s tor inspection shall be made 24 hrs.in advance-phone 259•8810 � <br />� � `�' 2.All v:ork shail he pedormetl in aceo�dance with this permit and curren!Cily ol [verelt Design and Cons�ruciion <br /> m a► Standard�and Specifications. <br /> 3.Cali LOCation UnCnrground Service AB hr;.belore you tl�9.TOLL FREE NUMBER 1-800•424•$555. � <br /> �... .�' <br /> � O <br /> �.s e� <br /> !� � � <br /> ...� ` <br /> � <br />, ��t � O <br /> Y� <br /> .s <br /> 4 <br /> ��r� <br /> �j�,�;,'�,:...t ;-,�.;f <br /> �CKNOI'lLE�G[tdENT OF GON[IITIONS <br /> .�,�� Ih��unduiniq��etl ownou.iPPlicant heieb�i anrecs Io hold anA snve hann� <br /> _ Ln/l�Cnnis Cn_iC'- '—_—_'____— <br /> less the G�y ol Evrretl I�om any antl all claims for tlainages costs <br /> expenses, ur causes of acuon that may anse because ol installation <br /> /�, / 3/�S/�� and maiMenance o� �he improvement or other righi�ol�way use hereto <br /> • /.�1.' !/�C�✓/%1— ipplied for and furiher a9recs to remove same upon nolice irom Ihe <br />� qpprrn:e f loi ConslNction ���� City�ntl to replace pu�hc pwperty dama�jed ther y. <br /> <.� �� / � ,.) <br /> ! i � E � � 7 `1 � � %,(� <br /> G��-rL' --_ ._,�. ,C� _� ���"L. �G G Z C.� <br /> FIt�AL INSPECTION D�tc - <br /> qppwved as Constructed Si natwe of Apphc..^I Dato <br /> WORK �UTHORI�ED BY TfiIS PERMIT MUST BE STARTED WITHIN <br /> �� PUBLICWORKSDEPARTMENT iB0 DAYS OF DATE PErIMI? IS ISSUED AND THEREAFTER IS TO <br /> �� 3200CedarStreet pE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A7AY BE <br /> [veretL lNA 90201 CANGELLLD BY iHE CITV UPON ANY STOPPAGE OF WORK ON'Ii15 <br /> Phone�,259�8870 P!70JECi OVER 90 DAYS DUFATION. <br /> I <br /> � <br />