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i <br /> , <br /> �� <br /> � <br /> ` , I �,� � � , <br /> Date�- ' � n�ni��wo,ti.P. t. �\,�1 �'� <br /> npPlicalion Fnr n °�°a o`o' • ��C����� <br /> a <br /> PUBLIC WORKS`�ERMIT �,,,���°W°,�°�°° --_ <br /> -o�.���� s <br /> lese Roni Feo Pe.a S .— _�l=— <br /> � 7� <br /> Print or Type Only � � �' � � B.�a�<�o�� S ���I� - <br /> o .�-� ci "a5' ci <br /> .+ .+ h O <br /> I i W M M �� <br /> .� % M r� I '7L� 1 R ���' /-�\�_ N� `.�J'�JT� ���- <br /> �� � �Owner Mading AAA�ss ^}{ a a � � Ciry Zip Phone <br /> ��) m S L� ll lTl � <br /> / �� <br /> Applicant MaihnyfjAdr.ss Gly Zlp Phonr <br /> Describe Propased Work �A�J -.1��� — <br /> Prolecl Adtlress lil knownl ���n�•�� 7 `��1� ___ __ _ � <br /> � <br /> Attach four(4) copies ol plans'or proposed wmk�Draw lo sr.nle and note the followin�as apU�ir.ahle � <br /> • Property Lines • Centerhne ol streel 'A <br /> • Outline and dimension5 01 ell existing and • Indlcale North v� <br /> proposzd ctructures on Ihe lot • Show any pwposed{3r�rlinq chane7rs <br /> • Existing and proposed ulillties • Show measuremrnis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT COND�TIONS O <br /> 1.All calls for inspection shell he made 24 h�s.in advance-phone 259-Bfi1 O. � <br /> 2.All work shell be pedormed in accordance with ihis permit end wrrent City of E��erell Design and Construclion <br /> Slandards and Specilicadons, <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424�555h. � � <br /> /� �"�►, ��,-�t,,. ��� .,•r' (!� �P� c�._ /'� F3�S O <br /> � <br /> N <br /> O <br /> a <br /> �CKNOWLCJG[M[NT OF CONDITIONS <br /> `� �-un�fr�s�yn��d owneUapplicant hereby ayiees lo hold and save h�rnr <br /> --'— -. I�^�s Ihe� Gly o� Cvere.tl �rom any and all da�ms lor dnmages, costs <br /> `� . . ,, e.pensrs. or causes ol action thal may �nse because ol Inslallal�on <br /> � % - � _ _J.,'� and mamlenancr, ol ihe improvement o� olher nyhl-ol-way use heretn <br /> - ' � ' � '� � apphnA lor and lunher agrees to remove snme upon nolice Irom tnr <br /> Appro�for Construr.tio�- Date C�ty�nd lo replace public p�operty damaged Ihe�e6y <br /> ///� <br /> //` 7 <br /> ^'f <br /> �l'ut_f`/�L / ' �� . <br /> �r / <br /> FI Al INSPECTION ��' L�� ' �� �a�e �.� LC � ��,. <br /> AnP�oved as Construcled Sic�na ure ol Apphr.anl - �� Da�e <br /> rvrrpll PUBLICWORKSDEPARTMENT WORK Al17HOflIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedurStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PEf7MIT MAV �C <br /> Evtfretl,WA9B201 CANGF.LI.f.f1 BV THF CITV UP(1N ANV STOPPA(:F.O�WORK ON iH15 <br /> Phonc P59-99I0 PROJF Ci i1VC H<�n DAV.', [�ilHnllflld <br /> I <br />