Laserfiche WebLink
�e�s <br />, APnl�r,ation Foi <br />PUBLIC WORXS PERMIIT <br />Print or Type Onty <br />// <br />o- /a; 5T <br />Atldress <br />/f <br />MTilin� Address <br />r��i,i�� w�,�w. r�.���n . <br />o�mi ooM • _ <br />�sl��� <br />__ � _._. <br />Putilic Wo«eiqe s ��/� � — . <br />Tolnl fee �� <br />l rsn hpC�'� I ec PnN S_ <br />Baimcn pue b %� _ <br />= �; -- Ti 98 <br />niY z�u <br />� /i <br />/ <br />Dnscrlue Proposed Work �/.L� /� 01�� �/i'P��� C-�" /v/ ��1� i� !- ��/ I C /�_ /l !J <br />/�UDC'� /�/9i�S <br />- � <br />Piolecl Address (il hnown) <br />Altach lour (4) copies ol p�a^s for proposed viork � Draw to s.ale ,anA note Ihe Iqllowing ns aVPlicable: <br />• Property Lines <br />• Ou�lina Bnd Aimnnsions ol all erlstiny anA <br />prnppsed siruclures on Ihe lot <br />• Existing and proposad util�ties <br />PERMI7� COIJDITIOIJS <br />• Genterline ol sVeet <br />• Indicate North <br />• Show any propo5ed graAing changes <br />• Sho v measurements <br />LINE <br />t All call; lor �n,Vec;ion shaC be made 24 hrs. in advance - pho�:e 259•881 5. <br />2. All work shAll bu perlurmec m ac� ;�dance wi�h IhiS permd and current Gty ol [ven:it Des'ign antl Constructian <br />Standards nnd Specil�catio.is <br />J. Cell Location Unaerqrountl Serv�ce 4& hrs belore you diq l OLL FREE NUMBEH 1•800•424•5555. <br />y_ F,�� ,,;��_� ti�rv <br />/�L�llis� ���` � <br />� �- <br />r� (�%, < � <br />^� ", <br />,r,ll�Ll 1 ��I�. � <br />(' /� <br />�'x,{ �� ���-� <br />� <br />--��� �� , <br />� ,��"" �� i - <br />�� / <br />ved oT r Co ructio � —�� Dale <br />�" <br />F�N4. ' JSPECTION <br />qppioved ns Constructed <br />rvrrel� rUBLIC WOFhS DEPARTMENT <br />� 3200 Cedar St�eet <br />I'vrrelL WP 9D201 <br />���.,�nn� 259-E3E7I!i <br />Dale <br />C'J � /%�/ -/ �E�v!/�'�/ <br />s ly l �c,- <br />1� <br />� <br />� <br />u <br />1 <br />M / <br />O/� <br />� , I�b, <br />PCKIJOWLEDG[AtENI OF CONDITIONS <br />'n�� u��d�������i��,��d owneVapphr.ant her�by agrees to hold anA save harim <br />i���..�. �h�� C�t�� rd Everett Irom eny and all clalms lor dama4�es, cos�s. <br />��aper�.es oi causes ol acllon thal may anse brcause ol installa�ioi <br />and maintr.nance ol thc improvement or othrr nnhPobwnq ��,�� n��retu <br />flpplied lor end furihor ag�oes lo remove samo �q�nn nr4a�• Lon, �hc <br />Cily and to replace pubi�c properly damaged Ihen�l,y <br />'- ✓� � � �✓`"'�' L � �C�J _.. <br />7 <br />S�ynatun� oi nnui�ca�,i ��%���' <br />WORH AU7HORIZED BY THIS PERMIT A1U5 BE STARTED WITIII�' <br />1P0 MYS OF DAT[ PFRMIT IS ISSUED AND THEFEAFTER IS 10 <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PEFiMIT MAY BG <br />CANC[LL[D BY THE CITV UPON ANY �TOPFAC��[ OP WOPK ON THIS <br />PRpJI�_C1T OVI R 90 �l.VS DUR�TION <br />