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o��:��,. <br />Apphcation For <br />PUBLIC WORKS PERMI"i <br />Print or Type Only <br />•T <br />SIv (Zl ST <br />Mading Atldress <br />Maihnq Address <br />E�cc�-f <br />City <br />��,�� �.\I � <br />Ci�y <br />�>>-�� <br />i�,r�i����a�...r,�.,�.�. `��`' — <br />ui i�� fi.t'. • .._ __—_ <br />��,i�i�, v.o�w�t.� f _—_'_ <br />L,iai r.e _.__ <br />essAp�i� feePnm S _ <br />� . f / J,? C�` <br />u �ian� � Jue <br />—�-����� --- <br />Zip Plwn� <br />��1— <br />Phone <br />�� .�. . ���\_: !ft1�JlV � �_7.�s�:i� � ��t�ii�a <br />i___'—_ _ � � <br />_ � �� <br />Pro�ect Add�ess lil known) I� 1� �Z� — S�[ _�� t� _. <br />Attach lour 14) copies ol plans br proposeA work - Draw to scale and noto Ihe following as npPlir.abl�� <br />� p�o�g��y �mes • Cenlerline of sircet <br />• Oulhne and dimensions ol all ezisling and • InAir.ale Norih <br />proposed s�ructures on Ihe lot • Show any prnpo,�d qrndmp ch�nyes <br />• Eaisting and proposed u�llities • Show rnensurements <br />LWE <br />P[RMIT CONDITIONS <br />t All r,alls lor mspection shall be maAo 24 hrs in advance � phone 259•881 5 <br />. All work shall6e perPormed in accordance with Ihi; permit and currenl City ni Ceeiett D��r•u1n and Const�uction <br />Stinaards and Sp�cifications. <br />3 Gill Localion Underground Service 48 h�s. belore you dig TOLL FREE NUMBER 1•800•424•5555. <br />y�vv,P.r j�� h r ,d��tiF ��c-,�• SE, �� „ y_,s�, <br />, <br />,> : %i/� l��rC�nlTioiv f ^�c �/� ci'_ ' . � �� / ,� s,-" i�:�e Fif C; Tj Es�t <br />S' ;.�,,,��»�'A '�, . ,'+ <br />•-'�,c tA.rFy-c;r,v� ✓� w.•n <br />C_� t� !1? . �1–. J/ilfi'L� <br />APP��vud loi GOnS�rU (IQ�_ � Da P, <br />, ,-�// ; , <br />��� :� <br />FINAI IN3PECPIOK � r i � Dale <br />Approved as Construcled � .•_. � I , , . . �;� . , . . . <br />�,�,i,��,❑ PUDLIC WORKS DEPAP7MEIJT <br />� 3200 CedPr Streel <br />fvure�t. W� 98201 <br />f`hnni• 759.NI3I', <br />A(;hNOWLGDG[MFNT OF CONDITIONS <br />W <br />H <br />� <br />� <br />ih�• und��r.�qn�,d owneUePPlicanl herebY �grees to hold and r,ave hruim <br />less Ihe C�ty of Gverelt Irom any and all claims for damn9es. � o�dti. <br />eKpenses. or causes ol aclion Ihal may anse becnuse ol mstallabnn <br />and mamtenance ol e imp�ovement or other righPobway use hemin <br />�pphed lor and lu er agrees lo remove same upon notice M1nm in�� <br />City anA �o repl e public prop�rlY damaged �hereby. <br />; <br />� - �/ �' f��% � <br />�i- ♦ i � `. <br />SignatureV(APPIic V D� I�• <br />WORK AUTHORI2�D BV THIS PERMIT MUST �E STAqTED W�1���'� <br />IBO DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS '�� <br />�[ DII.IGENTLV PURSUED TO COMPLETION. THIS PEf7M1T IAA�- iu <br />CANCCI.LCO �Y THf CI7V UPON �NV STOi'PAGf_ Of WORK ON �' �' � <br />I'HOJf Ci i1�I.H'JO DAYS DUf7�11nN <br />