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� APPLICkTION FOR PUBLIC 1h'ORKS PFI�MIT <br /> Type or print ela�AY wlih Ink <br /> PRESS HARD-YOU ARE MAKIN6 COPIES pERM1T NO.�/S� — <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON / BLDG. DEPT. fJO.������� <br /> ❑ OWNER ❑ AGE�:" DATE ��rf�� <br /> APPLICANT/FIRM REPRESENTED _4 _ArV,QY�R.J.SLL'._ ___<f��j2�'�fl.;_CQ��— <br /> ADDRESS ���11.Ei -�_ CIN 1,'.f1�--TEL�PHONE �3-.3.Z�-S <br /> HEREBY APPLIES FOR PERMISSION TO _ ��_____, ra _s%� �"''�, �t/ �'�.����� <br /> Z <br /> 0 <br /> � <br /> -- - -- -- - — .. <br /> / � n <br /> AT THE FOLLOWING LOCATION 1.��% � � � � �V�r4�/'�9 G`o/"1 . �`� `�' <br /> �� p �T � <br /> / �Ar6Q/ct ctnt .� .-. <br /> Attach five(5)copfea of preliminary plans for propoaed work Draw to scale and show thrr fuilowing as applicable: � '^ <br /> .. � <br /> N S <br /> • Property Ilnes and street identity. • Topographic chanUes requiring cuts and Nlla o m <br /> • Outline and dimensions of existing and other thAn r�usmal foundation. m o <br /> proposed structures. ' On-site �'rainage syatems when required. �� <br /> ' Exlsting and proposed utilities. • Erosion control methods when required. �' ,�. <br /> • Centerline of abutting right of way. ' North e� _ � <br /> / ; m <br /> .. <br /> ��,/,� �s�rx.-1J� _ .o z <br /> `S eWro ol Applicent <br /> PUBLIC WORKS PERMIT r N <br /> � <br /> O .'� <br /> CONUITIONS; 1 " � <br /> 4 . • . . . . 1 Q �j �Y[���.1\ ar C1.:1rv�M�1H\ �G vkta,-. . = m <br /> � . . . . . . . . (• CONO+fNt T�o.. � (ANs � � m,,, <br /> I . . . � ' . . � . . .-i+/ �r0.�.. .mr SNwGr W4r� m�w1 � �4e R-�Pf'OJIa9 b . Of' <br /> ( . • . . . , T�`G \ N�'J�1�. yyo.f��i �NSQI'M� r �R �OR � SfQ��v1` mN <br /> � J <br /> ` . . . _' . . . . . 1Nor'�',. . . . . ;'i m <br /> I <br /> I � p <br /> . 2. �l� OfSc4��c c�e�oris P�0.t�� av� .a��acr.-.� �� � N�w �•�- �aG 7O <br /> ; � . � <br /> � . . . .-.._._.. . � . . . G�[Pf�<�'�i'o.++ . �� W[1 . � . . . z <br /> . . . . . � . 4":� . . . S <br /> y. : . _; .. _. .. . � . . . . . . . . . . . . . . . . . . . . . . . ' . . . . . . � <br /> � N <br /> � �/� Z <br /> � . . . , . . . . . . ��^��� �� ���..�'I/� � <br /> ' . ._._. .. .. �_ ... . . . . . � � i �L � �� r. <br /> m <br /> , . . . . . . � � Q��/��� � � <br /> , . . . � . <br /> , . . .�__._ . . �, "`_ <br /> : _ , � � � . T e undermyr tl wr.er hemb eqrxe9 to�ald enU eava �ermlaee <br /> Ihe City ol Ev 11 imm any na au :I�Ime lor d�mape�, coala, <br /> ; . , , , . . , , . . e.panses,or uu e of ection t t m�y arue eeausa ol InneilsUon <br /> . . . . . . . . . . . . . . and melnlrn�nco ol I�e improvement or other tl9M•o4wey we <br /> . . . . , flelelo GpP��etl lOr end lurthe�apree�to rcnrove ume upon nollce <br /> Irom t�a City entl to replar,e Dublic propetly E�m�qed I�ereby. <br /> �%�3- �/-�3 <br /> APPROVED FOR CONSTRUCtION DATE ACK W ' EN CONDITIONS <br /> APPROVED�iS CONSTRUCTED DATE SIIiNATUfiEQ PPLICANT 6 T � <br /> PERMIT IS VAL.ID FOR 1 YEAR pOST ON CR�L FOR INSPEC710N <br /> 259-8811 <br /> EXPIRATIOM JOBSITE 2q HRS. BEFURECONSTFiUCTION <br />