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� ` <br /> _ _- - - -� <br /> i <br /> � w APPLICATION FOR PUBLI(; Wt�RK� PERMIT ; <br /> �, � iype or pr�nl ciearlp with ink �o� 5 3 '� <br /> I PRESS HA�7D-YOU ARE MAKING COPI.cS 4:�' <br /> PUBLIC WORKS PERMIT NO. � <br /> i E'JERETT,WASHINGTON � ' / BLJG. DEPT. NO.$a o _ '� I ' I <br /> i ❑ O�NNER ❑ AGENT DATE ___���J�J� � <br /> � AI�PUCANT/FIRM REPRESENTED _ ___� � �� r� � \-. �� ti ��T._ _ � <br /> ADDRESS � � �'_�� �Z� / CITY ' " S�TELEPHONE ZS��"2�'�O� ,' <br /> i HEREBY APPLIES FOR PERMISSION TO _��`�� �� ��� �X I St! ��1 �(� I �J�LC� ry�-C�j � i <br /> I - ` ^ -- <br /> AT THE FOLLOWING LOCATION _��� Z_____�f�-0��-'7`'� <br /> '� Attach five(5)copies of preliminary ptans for proposed work.Draw lo scate and show the following as applicable: <br /> • Property lines and street ide�tity. ` 7opographic changes requiring cuts and filis <br /> ` Outline and dimensions of existir� and ot��er ;han normal foundation. <br /> proposed structures. ` On-sile drainage systems when-required. <br /> ' � Existing and proposed utiii�ies. ' Erosio control r�ethods �n required. <br /> �� * Centerline oi abutting right of way. �North �W � � <br /> � <br /> , � <br /> ' / � � . � � <br /> _ •_� ___ <br /> � --.�i-'gn5tuieo�nun�icent I <br /> �� PUBLIC WORK'3��PERIi�li1T ��� <br /> CONDITIONS: <br /> ', yv r i� �'v�vr.�;��7- Ci`J, i,c ) ��,T�s <br /> __. � . <br /> � , i � . . . /,�/�/�/� ?� CU Gc�/1/C'��r'n�J i�i9�' 7��� ���/<y; <br /> . , . - . �u/�•OjiJl�' (�J/�c �lo T .t5�c` C'C'cc.P/c� , Gl�J%/t. <br /> � �� <br /> � � . .-- - ..�--� . . . . . <br /> I � ..: . : � y('�.��9i,�s��F'r.��,�rr-���� T.s r�7�r- .,—� <br /> � <br /> I _---,-;_ .. . . . .T-i97�ic1'��9 c.Tr. �n�. . c?F �i,�'',c i c : GTJo,c�.�'J` . . . . . . . . . <br /> � i . ; � ' . %iJJ�r� 7��`' . : : . I <br /> � �...� _.. . . . . . . . . . . . . . <br /> ;_; � <br /> I I_� . <br /> � � , , � . . � The unaem{�2A owncr -�ereby agrt.ea b hola end save ha�m1855 <br /> i �� , , . . Ihe City o� E.?retl i�om any ano an ciaims br f.amepes, costs, <br /> � � ezper�es,:.'n. �sen of action ihat may u.ise becauee ol inetallation <br /> I � . . . . . . . . . . <br /> i . .. . . . . . . . . . . . . . . . . . . . and r. oint�^c�ica ol Ihe improvemeN nr other righl-of�way use <br /> I ; � � � � � � � � hereto appb� d for nnd further agrees Ir. remove same upon nolice <br /> � '� Imn. Ihe Cil� and to replac= public prc0erly tlameged thereby. <br /> I . �•� ---) � •� � . <br /> i l ������S= ..�� � � . . <br /> �� AP . O E OR CONST�UCT DATE ACKNOWLl6GEMCN'''GI�yCN161T1!)NS J <br /> ^ i <br /> 61 2 „ � , << �.' � � J Z� <br /> � U � f5� �'—/ � � �=--- <br /> I APP OVED AS CO S � JCTED D,'.E SIGNATURE OF AP?UCANT - � DATE , <br /> 'i PERMIT IS VALID FOR i YEAR pOST ON CALL FOR INSPECTION <br /> JOBSIT� 259-8811 <br /> EXPIRATION �4 NRS. BEFORECONSTRUCTION <br />