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De�¢L2�_Q3 ( �.. <br />�pplketion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />vwx«en.v...x. 7j � ` <br />ene oroi.. <br />vuea wem rro <br />ia.ire. t <br />�n��on: r.� o.0 t <br />e.i.�ce o�. l 2 O�� <br />�i�b�^.cTA:ti� z���� RO�QJI n��ii rs L:1A. 9�i �r �� as-��?� <br />Owner MnINngAEtlrecs Cily Zip Phane <br />I�aBF3c�'�+assainl r�z���tpda�. n!-G µ�o uNv� /.�JA.. A9zzs' �rp[•�)�s'-7taB� <br />�onlicam Melling RtlEresn Clly Zip Phone <br />Deec�IGeProOoeeOWork LMATG Y���ft� �TA�LL�(�dAL1T771CT1�2� iJiFilFLJ� <br />_ � <br />Prolecl AdErese lil known� <br />Rtlech lour (4) caples ol plens (or pro0a9etl work � Orew lo nrale enC nole Ihe lallowinq ee eppliwble-. <br />• Property Linee • Cenlarline ol61ree1 <br />• Oulline end tlimeneiom ol all exieting enE • Indicele Norlh <br />p�000!¢O SIf�C1U�B6 0� 1�� 101 • ShOw BOy p10006Bu AfBdiOg LheneC9 <br />• ERI6�IOp e�tl p�OpO!!E U�Ill�i!! • Show meeaorem¢n16 <br />PERMIi CONDITIONS <br />1. All calle lor Inepecllon shnll be metle 24 �rs. In e0vence • p�one 259•8810. <br />2. All woA shell be pedormed In eccorAance with t�le nerml; enC curtenl City o1 Evarell Deelpn entl Constmrllon <br />SlenEvtle end Specllicet�one. <br />3. Cell Locetlon UnderpmunE Service 4B Na belore you dlg. TOLL FREE NUMBER 1-800•A24•5555. <br />� w_�-.Cpr..aq. %�24,C%� .e.C. l.rt/ OxC. �lallUJ p� (7j_ ����.5� <br />�^�-� ' C.Sit,. d70.tJi-•� C�C�ty�JO l <br />� <br />-��� �� !� /� <br />APO�a�e4101 COn61NCii00 ate <br />FINAL INSPECTION 081e <br />AOO�OYPQ 06 .r.006IlUC�l4 <br />�PUBLIGWOSNSOEPARTNENT <br />��00 CeOar Slreel <br />Ererelt W� 98P07 <br />P�one 258�8810 <br />AGKNOWLLDGEMENT OF CONDITIONS <br />� <br />O <br />'�^ <br />Y/ <br />O <br />a <br />T�e untlersignetl uwner/npplicxnt hereby egrnes to �ola ancl seve harm- <br />less I�e G1y ol 1'verett Irom P11y 0�� 811 CI91T6 IOI C0TlQP.6. LOSIQ <br />e�pense6, or ceuaes o� ecl�o� Uiat mny xrise because ol instellalion <br />pnC meintenance ol l�e improvemenl or ot0er rIB��'ol�way use �ereto <br />ap01ie0 IOr end hrther eqrees lo remove seme vpon nolice Imm Ihe <br />Clty a lo repmcn publk ronerty damegeC Ihereby. <br />L-�s-1�"3 <br />iq alure o� AOVlicent Dale <br />WORN Al1THORIZCD BY TNIS P[PMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATF PERMIT IS ISSUE� AND THEREAFTEfl IS TO <br />BE DILIGENTLV PUNSUED f0 COMFLETION THIS PERMIT MRV BE <br />CANCELL[� BY THE GI1Y UPON ANY STOPFpGE OF WORK ON THIS <br />PROJECT OVfR 9U DAYS DURATION. <br />