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Dat����� �� <br />Application Por <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />��„�,:,,.,.,�.,,m,. _"'; a�y? <br />aiay oon� � -3 a� 7// <br />CutrL�W4�hnFne 6 ��,U� <br />le��� feo <br />i rs�: �Doi fen Pma f <br />o: �.a��, n�� S-7-0 . U J <br />�� /` r <br />�py�en Realtv Inc 1429 Broadwav __ Evcre�� 98201 252-1166 _ <br />Owner Mailiny Address C y Z�p Phone <br />Aoyden Real[y, Inc., dbn J 6 D Builders, 1429 Croadway, Evaret[ 992U1 <br />Applicent Mailin3 Address Citv Zlp <br />Desc�l6ePropo�edWork _ NeW SSngte P�milv Res�r:aCa . <br />Proi��clAd�resell�known) �tiL•�Ft!1_P��S-R_ - P=L'111pj.RpT�L <br />qtt:�r,h Inur (4) wpies oi plans fur propos, :::.r!: 'v�aw to scalc �nA note thr. lollowing as npplicubk� <br />• Properry Llnes <br />• OuPlne end dimensions o! ell r.xisllny nnA <br />; �aposed stiur.lures on ihe lot <br />11 Fa�.s.ing nnd proposed u�llities <br />PERb11T CONDITIONS <br />• Centerline of street <br />• Indicate North <br />• ShoW any Gn�Po�-,Ed grmlin0 r,hunqrs <br />• Shuw measureme.nts <br />252-1166 <br />t77� .T7SS <br />All cells �or inspFc�ion shall 6e matle 24 hrs. in aAvance � n��onc� 259•881 5 <br />All work shall be perlormed in nccordancr with tMs permd nnd current C�iy nl E: ����li Drsi�,7o , nd Coi��l�ur!�on <br />SlnnAards and Specificntions <br />Cnll Localion UnArtryrOunr� Servicc 4R hrs hc�urn you diG TQLL FREE NUMBER 1•6��•�i24-rJrJrJ$ <br />__l �i j' f '. __ <br />�/�.,,/��` /G'( if-_� ; � 1 -%S <br />App�oved for Consiructlon Date <br />�.R� � �� <br />FINALINS�ON I\`� \ 00t <br />App�oveA as Consl�ucted �% <br />e�vr�rrtt PUBI.IC WORKS OEPARTMENT <br />� .i2C0 Gedar SVeet <br />� � �verolt WP 90201 <br />f�i�,. �.�,�n�,�,, <br />� <br />ACKNO��'- EOUEMEN; OF f,qNUITICNS <br />W <br />H <br />�w� <br />w S <br />� <br />� <br />The„nd�°"��.i^ec^.nnr;�.r;' .. "-rr nd;9�rr7,�oldandsaveharm� <br />Inss ihe C i� nf Eve�atl hoc��a•n =7u +II clalms lor damnpes, cosis, <br />enGenses. ur oouses ol nction ihat mey xrise because of Installation <br />and mnlntenance ol the impwvement or othe� righl�nl-way use hereto <br />aUPlied br nnd �urthe• agiees to remove seme upon nolice Irom the <br />G�ty end to replace public property damaged thereby. <br />� " ,' l ' f� . . . 1 -i <br />t�...' � ♦- / . . <br />Signalurr, ol Applicant Dale <br />WORK AUTHONIZE'J BY THIS PERMIT MUST BE STARTED WITHIN <br />1d0 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER I� TO <br />HE DILIGENTLV FUHSUF.D �f0 COMPLETION. THIS P[RMIT IdAY �F. <br />�;�1JC[LLFD BV THF CITV UI'ON ANV STOPPaCF O� WORK ON �HIS <br />i��;� i ii ci , ��,-C i. ��.� ��,^,'�f. Ui �t7nii�ir.� <br />C <br />