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DateIL3 �'r 'Z'� Putibc Works Permoil•��°�y/� <br /> Applicaliun For e�ao Dew • —d�! � �� <br /> PUBLIC WORKS PERMIT °°°°°W°-.�.. - -- <br /> Tol�l Fea f— <br /> 0 <br /> Le�eADC� FeePud �__ <br /> BtlencsOw <<�U <br /> Print or Type Only � � <br /> C��1� �KKELn'r�i)1��' /�>� l N�'Y �i 5 ��CI?f77 y�;u�y 35 j -did,l <br /> Owner Mailing AdJress Ciry Zip Phone <br /> /�9ti[k�A:l �l��!'�E-"� �f' 7 /`f E L z"1��?� %b'��C'G �1 ll� I) <br /> �pplicant MeilingAddress City Zip Phcno <br /> Oescriba ProPosed Work ����1,4'"V �,��'`��l�� � •���� `-�- �/,��/L � �( '�Q��� <br /> W <br /> /OX yT if�� S-�'- � <br /> Project Address(�I known) / — <br /> Atlech lou�14�copiea ol plens lor pruposed work� D�aw lo scnle nnd note Ihe lollowing es appilcable � <br /> • Proper;y Llnes • Centcrline ol s(ree� QA <br /> • O�itline end dimensions ol nll existinq nnA • Indicale No�lh V� <br /> prOposed sirucWres on fhe lol • Show eny propoeed gretl�ny r.hnn�es <br /> • Existing pnd prpppsed utdilies • Show mee9uremenl5 � <br /> DO NOT WRITE BELOW THIS LWE O <br /> PEiiMIT CONDITIONS <br /> 1 All calis lor mspec�ipn shall Ue made 24 �rs. in edvance- nhone 259•881 5 � <br /> 2. All work shall be perlormer'in accordenr,e with Ihis permil and cunenl Ci1y ni Lv��ret1 Das�y•� ;�nd Constructici, <br /> S�enderds end Spetilice�ions <br /> 3. Call Location Untlergwund Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. � <br /> / • O F <br /> /. /17 ����G�''�i✓/�.t�' � Y��:Ci/�«C? � <br /> � r: <br /> � <br /> ,A N F <br /> V� " , <br /> � � � <br /> � <br /> a � E� <br /> �, ; <br /> , <br /> -- � <br /> � . <br /> �-: <br /> ar:i<NO�b'l EUGEMENT OF CONUIiiONS r� �. <br /> 'Imund�-��,�c�n�r��,�vmer/eppllcenlhBrebyegreestoholdendceveherm- �' : <br /> �- � � i���s, mr C�ry oi Lverr�tl Irom eny end all cleims lor demages, eosls. ,� ; <br /> � -� l I e�penses. or causes ol ection Ihal may arise becausa ol Installetion .� <br /> and mainlenence ol Ihe improvement or olher righbol-wey use h�relo - <br /> �� �'� apPlied for and further egn:es to remove seme upon nolice Irom Ihe '" , <br /> nt n etl lor C .t n Dete City and lo replece public property demaBed Ihereby. <br /> � <br /> .�'ti- �� L�s `� -' - !/ y;zy-� r <br /> fRlAL INSPE TION ; Dele — - <br /> qpproveA as Constructed � � SigneW e of Apphcanl � Dnte � ' <br /> WORK AUtHOR12ED 9V THIS PERMIT MUST BF. STARTED WITHIN �" <br /> �.�,y�q� PUBLIC WORKS DEPART�ENT '�; <br /> � .�200CednrS�rex� 1B0 DAYS OF DATE PFRMI7 IS ISSUED AND THERFAFTEH IS TO - <br /> [�.veretL WA 9A201 BE DILIG[N fLV PURSUED TO COLtf't fTIO�J Tl11; PFRPdIT MAV BE <br /> fTone 7fi9�8815 CANCELLCD BV THF.CITY UPON PNV S1nt�f'h,f �>f WORI<ON iHIS <br /> PRi)JF(:i fiVF� :��1 IIAVS f1�J17AilON <br />