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Date/��C/���`� <br />� <br />Appl�cetinn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�C <br />Applicanl Meiling Address <br />Desalbe Propos.�ti Work <br />Pro�ect Addreee pl known) <br />i�y <br />L� <br />�„ 3� <br />r�nm,. w,,,., o��m�i . <br />tlm� Deo� � ___ ____ <br />PuEbc WorY�hs e �Z � :� <br />Tol�l Fee <br />Leu A001 ip� Pe�d `. <br />_ e a <br />BNe�ce Dve <br />% i <br />.Sri9TT� � GJ/9 %��CS.T <br />r. <br />/1/ �- • <br />�.� �n.7y ` QJ� <br />Z�G Phor,e <br />Alloch fOw �4) cople9 0l plans lor propoletl wo�k - Drew to Scnln dnd nole thr tullo��ing es ep0��ceblP <br />• Property Lines <br />� Oulline end Almenaions ol ell eMisfin4� nnA <br />propoaed sGuctures on tne lot <br />• Eriating end preoosad utilitie:, <br />PERMIT CONOITIONS <br />• Cenlerline of strc+e� <br />• Indicate Norih <br />• Show any propo5ed praA�ny Ji�ncaes <br />• Show measuremnnls <br />All calls for in9pection 9hall be maAe 24 hr5 in aAv�cce � phone'1$9•88� $. <br />All worM shell be per�ormed in eccordanCe with �M9 permi� and currenl C�ty of [veretl Design �.nd Gonstruchon <br />StendarAs nntl Specilicetlons. <br />Cell Locetion UnAer3round Service 48 hra. before yoi� tlig. TOLL fREE N�JMBER 1-800-424•555�. <br />� 7�iJ' !_� T J"�='�'�' � /`� /j� .E%FT .STi9T� v � <br />� ;_'r� �S1/�'�/��l� �SCc`2:�' �Sc�F'i�iC� � �`�� <br />�'�rf- �.� � .� � r !�< < c�r�v T,�- <.�� -=. •r,y� �� �J <br />rr�� oiA`-�J9i7�� � �%��n�T '�' ��F r�/i.l' �i47_� <br />Dc�c �.�i�Ncy o/� �f'r si���r'� c.Ji�c irlo T,!}�r <br />y« ol�lZ+� s./1% ri� T,=� �;,y �l'c c��• r,�r c,�,— <br />ST�i ��J/�% . <br />, <br />� -� _ /� � G c�'.S <br />Ap ved f�� Ge str on Date <br />FINAL INSPECTI� , �le <br />Approved es Construcfad <br />rvrrNtl PUBLIC WORKS DFPAqTMENi <br />� 3200 Ce inr Strael <br />Everetl, � IA 98201 <br />Phane 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unde�signed owneUepplicant hereby egrees lo hoid .,nd sav� ha�m- <br />Iees �he Cily 01 FvereU M1om eny end all rlaims Im ��.�nayes, rusts. <br />e.penses, or ceuse� ol aclion that may erise hecause cl mstallahon <br />and mamlennnr.e o� Ihe improvement or olher nghl-of-wny u9e herpW <br />apphed lor nnd lurther ngraes to remove same upon nolice Irom the <br />City end to replace puhlic property dnmagetl the�eby. <br />�/ `//� , � /' � �. <br />_�1 ' � C <br />Si9nature ol Applicanl � ' p,�i„� <br />WORK AU7HORIZEO BY iNIS PFNMIT h1UST BE STARTED WI�HiN <br />1B0 DAVS Of DATF PERMIi IS ISSUED AND THERFAFTER IS TO <br />PE DILIGENTLV PURSUED TO COMPLETION THIS PERMIT MAV BF <br />CANCELLEO 6Y THE CITV UPON ANV STOPPAGE OF WOR.`( ON THiS <br />PROJECT OVER 90 DAVS DUflATION <br />