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r -� <br /> 1 <br /> ""`"` APPLICAT�ON FOR PUBLIC WORKS PERMIT <br /> � Typs or DHnI Us�tly rllh Ink <br /> PqESS HAND•YOU ARE MAKIN6 COPIES pERM1T NO. g� ��� <br /> °' PUBLIC WORKS p^ � <br /> � EVERETT,WASHINGiON BLDG. DEPT. NO(La' D-�� <br /> � � f ' z <br /> L' OWNER �AGENT DATE _ _- �. ___----. <br /> APPLICANT/FIRM REPNESENTED �ui�����9---CS'�-."< .`� __ . _-___ __--__— <br /> � Sc • c.�J`/ `t IIJu CITY �u-5�� TELEPHONE ����I'bl�`.Z' <br /> ADDRESS —� `� �'L �1-- �-- <br /> HEREBV APPLIES FOR PERMISSION TO _1.Lf''' F_K t �,'i i ti.11, (�� 1����� <br /> •�r'i.�v� �l ��v_....� �.c{d�� �1�0 .-. — <br /> � <br /> ATTHE FOLLOWING LOCATION _�I__� A/�lL El� �__ <br /> Atiach five(5)copies of prelfmfnary plans for proposed work Draw to scale and s�ow the following as applicable: <br /> ' PropeAy Iinea and street identity. • Topographic changes requiring cuts and filla <br /> " Outline and dimensions of exiating and uther than normal foundation. <br /> proposed structures. • On•site dralnege systems when required. <br /> • Exiating and prnpoaed utilitfea. ' Erosion control methoda when required. <br /> • Centeriine of abutting right of way. ' North w <br /> „���,.-�l� <br /> -- SlpneNro ol App��cant <br /> PUBLIC WORKS ERMIT <br /> CONDITIONS; <br /> � , i . <br /> ; . . . . � � . . � . . . , . . <br /> � . . . � . . . � . . � , . ' i : ; ; . . , . ; . . . . . <br /> i .._' -;. . .___�-._.. : , ;__} .._..,. . . <br /> l . . . . .__. _,_ � . . . . . . . . . . . . . <br /> � . . . . . . . + . . . ; . . . , . . . <br /> . . . . . . I . . . . . . . . . <br /> � . . . . . . . � • ; � �� _� �_� . �._ __ . . ... � ._ • _. <br /> ( _ . . �� +- -�-• . . . . . . . . . t_ . . <br /> • . . . . i . . i � . � . , � . . ;T. . . , � . . <br /> . . . . . . . , . . . i <br /> . <br /> �.w�-._:_.._.-. i..._»..-Y. .-�_�-� -._.. . _ . . ♦_... .. . . .. . . . . . <br /> . . t . . . � . � . j . . . . . . . . i . . I . <br /> . . . . . . . I . . . � . . . . . . � . . . .. <br /> � . . . . . . . � . . . r . . . � . . t . <br /> h-"- '�"""" "'-"� �-���� The undereipned owner �eisby �p�ess to�oid ��tl urs h�rmlen <br /> . . «.� rt '.~-4 . . . . . ' � . � 1 , Ine Clty ot Everell Irom �nY �ntl ell cl�lm� lor GmYO��. ��I�. <br /> � eapen�a�,or c�u�e�ol�Ubn IMl msy�rl�s Deuuss M Innld4tbn <br /> • . . . • _ . . . . . . � . . . . . . . . �nd melnten�ncs ol the Improvement or ol�ar rlph4ol-w�Y Wn � <br /> � � , , , . . . . Asroto�pp�le0 Im�n0 lutlhar a0�ee�to rsmov�Nme up>a notk� � <br /> � Irom Ihe CItY ��4 �o �e01�cs OuClk propsM am�pW Mv�Dy <br /> l = . � _ ,3 Yz - � � <br /> PPR VE R C NSTRUCTION DATE AC WLE4jCi Nj OF CONDI?IONS <br /> ��A.i tU�c- � � ! 8Z� /��t�-`�_ — � <br /> AP R ED AS CONST CTED � DATE S�N RE OF APPLICANT DATE �, <br /> PERMIT IS VALID FOR 1 YEAR ppST N CALL FOR INt3PECTfON � <br /> 259•$811 <br /> ` EXPIRATION s - _; - J� __ JOBSITE 24 HRS.BEFORECONSTRUCTION <br /> � <br />