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i'J- l5. ... �ri�..... . ._ <br /> Date__ S 7 ������� <br /> Applir.ahon For H��v ���.�'r • . - --- <br /> PUBLIC WORKS PERI�AIT Punio�fe���� _ <br /> i.w�senoi r•.P.m 8 <br /> pei�nce Due S <br /> Print or Type Only <br /> �%i,� �. � � � i".r ' `' 1 ( , i 7 � �! ;S ' <br /> - ,�_ TG/� ��if'f,i s �.! s � < < , ;� y , > >.s � <br /> Ownar Meiling Atltlie98 Cily Zip Phone <br /> v <br /> � � � c_ C� ,n=��` � s_tf_,� � �.-� ��e � � snY ;•.>,s�t, S 4 � .> '--'-'=- <br /> r\ppficent Melling Address Clty Lp Phone <br /> Descrlbe Proposed Work V LC�AL� ..— ..— <br /> 7 <br /> Pro�ecl Addrnae(il known) 6"� �'���� r� �r J� — � <br /> J <br /> Allach lom i4)coplas of plens lor proposed Hoik� Draw to scele nntl rote the following es applicabie � <br /> • Proper�y Linee • Centerlinn ol a�reel � <br /> • Ou�line end dimensions of all eMisliny nnA • Indicate Norih <br /> proposed atructures on the lo� • Show nny n�oposed giatl�ny ��hanyes <br /> • Existing end proposed uliGties • Show measureuenls � <br /> DO NUi WRITE BELOW TNIS LINE O <br /> PERMIT CONDITIONS <br /> i. All celle br in9pection shnll be mada 24 h�s m aAvance � phone 259•8815 � <br /> 2. All work shell be pedormed in eccvdance with this permn and runenl Cit/of L.r�ed1 Ursiem antl ConslrwJion <br /> Stantlards end Spacilications <br /> 3. Cell locetlon Underground Service 48 hrs. belora you dig.TOIL FREE NVMBER 1•800•a24•5555. � <br /> ��i/ic /.� i� ���,� � _s , � . i�v., - A � . � �. :��i , . �r i � G -I�' -:7~ ,� O <br /> �-�-�T/.�` � <br /> / <br /> � <br /> O <br /> a <br /> At_KNOWLEDGFMFNT Of CONDI110NS <br /> lhr•un�.L���iqnr•rl owner/applicant hereby agroes to hold�nnl save harm� <br /> --'--�-�� - � - �� � - � - � � - - - i��ss R+r� C�ty ui Everefl Irom any entl 811 Cleims lo� tlama��es cosis. <br /> rrpenses. or cnuse:. ol nCtion thel mey ense becnuse ol mstallntion <br /> anA mamlenence ol ihe imprpvemnn� or other nyhl�ol-wxy use herelo <br /> __ _ _—- .-_ -__--- - --_._ -- oppliad lor and lurlhe� eprees lo remove same upon nolice �rom Ihe <br /> ApnroveA Inr Constrw:t�on �����' City end lo replece public prnpe�tY damnped Ihereby <br /> fINAL INSPECTION Dale _ <br /> Approv��d ns Constructed Si{7nnlu�e ol Appllcenl ��fl�P <br /> �.�� PUBLIC WORKS DEPAR�MENT WORK AUTHC�AIYED 8� THIS PERMIT MUST BE STARTED WITHIN <br /> � 3700 Cedar Slree� 1B0 DAVS OF DATE PEHMIT IS ISSUFfI AND iHEREAFTF-� IS TO <br /> f.�.��r-rrlL WA 9B20I BE DIUGENTLY PUFSUED TO CJMPI I 71C7N TIIIS PERMIT MAV BE <br /> Phnnr 269-HBIS CANCELLED BV THE C�T� UPON ANV Si(5PMf1F nF WORK ON THIS <br /> � PROJfCT l�Vf� <�n pAYS [�IIRATIUN <br />