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Date �1�v�� C � <br />Applir.alwn Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Apphcent <br />Madmq AAtlrNss <br />,.,�,�, w,.,.,,,. , b'6-- / o�- <br />n�nn o.�, . ,,,�� /���,_�� <br />I- <br />r'�n,i�r Wmb«n <br />im�i v.e 5 - — <br />��enu� rnrne�e S -__—__- <br />n,�.,��. n,�. 6 2�_ <br />��-//�/ <br />Mailin9 AdAre�s City Lp Phone <br />Descrihr Proposed Work _ n�,� L�l_JT C..C� _. l�T a sQ i�-4- g�) _ <br />Prolett AdAress ld knownl —/%// A� 8 •— �.3 ~d f�. .s �.fJ____ <br />Attach low �4) copies of plens lor proposed work � Diaw lo scale nnA notr u�e lollowing as :�npb��abh• <br />• Prope�tY Lines <br />� DIl11iI1P Hfl[: dI�IIP.OS�005 O� BII CZI5h11(j 2l1A <br />�fOpOSCd SVUC�LIfBS 00 IhP. 10� <br />• FMisling and proposed ulililies <br />�1 Cent�rline ol sUert <br />• Indicale Nortli <br />• Sh�w anY Prni�ns��J qiatl�nq �����.�ny��s <br />• Shnw mPasurpn ^nl� <br />PERMIT COND1710N5 <br />1. All calls lor inspectlon shall hr. maAe 24 hrs. in eovanr.e �ione 259•8810. <br />2. All work 6h011 be partormeA in ar_-prdente with ihis perrc � nnd cunerd City ol Everelt Desgn and Construrlinn <br />Standards end Sper.11icetions. <br />3. Cell locatlon Underground Service 4B hrs. Gelnre you di��. TOLL FREE NUMdER 1•B00•4Z4•55b5. <br />/. �l�iV.�JECT k'LK.1<-TUP Dar�ws,��r.�rs %�' I���iliN/'ii"m%� <br />�.SysrEM Ti�/�; .c'o.✓s B�:�s<•.✓o L n r Aj <br />.5,� ff.�� �cG� .O�ia-e�o -t�4o..,: ,a� .��Z� ..T`�hU�.l <br />� 1 �c.c.^fi��</,y/ .2.cN .Oce�urc✓�c- a,ize .�+.e'Ja.�/ -e.,,.n�.-GGs.��vs�i�✓ <br />�1�c�1 �GsKe� /l��llia-7�.�'f .?/r�*e:i �� �[iw� �,QE�Pn.if <br />� � <br />_____ �- �L�� y�lliDT�i J .J �g <br />Approved br Const r.lion Dale <br />FINAL INSFECTION <br />Appro�etl es CinstrucleJ <br />rvrreU PUALICWORKSGEPARTMENi <br />� 32IX� Cedai Slr�r� <br />Even31L WP 9620' <br />Phone [by�tlB10 <br />Dale <br />t,cnniowi.rocrMt Nt or coNomoNs <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />Thr. w�dersiynetl ownerlappl�cnnt hrreUy ay�ees �o hohl.u�d sav�� naim <br />lesa ihr. C�ly ol Evaielt Irom any enA all cloims for n;�.n�a�p,•. �,�s�:, <br />e.penses. or causes ol aclin� Ihal may xrise hec:msr� ,d inslalLd�nn <br />n tf mainlenance ol Ihe improvemenl o� other nqhl��rl-w,ry use he�elu <br />a�plied lor end lu�ther xgrees lo remove seme ur���^ nnt�ce Irnm ir,,. <br />City and to replace pubbr. propeiry dameged Ihe�rhy <br />/ ��L i <br />/� ['i �_.. / / � �� � ,: �.ira.� _ J '. % f [ _ <br />Sign.�Wre nl ApPh�an� Da�r <br />WORN ;l1THORIZED 8' THIS PERMIT MUST BE STARiED N�11HiN <br />180 D+��S OF DAiF PEFMIT IS ISSl1ED AND THEREAF�ER IS TU <br />BE DILIfiENTLY PURSUE� TO COM1API.ETION THIS PERMIT MAY H( <br />CANCELLED BV iHE CIiV UPON ANV STOPPAGE OF WORK GN t�1�S <br />PROJE�T OVER 30 UFYS DUR�710N <br />i <br />