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� APPLICATION FOR PUBLIC WORKS PERMIT <br /> Type w print claerly wOh ink <br /> PHE^uS HARD•YOU ARE MAHING COPIES � � <br /> PUBLICWORKS PERMITNO. �'� •�� <br /> EVERETT,WASHINGTON �` �i �I <br /> ,I�OWNER ❑ AGENT DATE _Zf �� 6 �� BLDG. DEPT. NO.________ <br /> APPLICANT/FIRId pEPRESENTEO uQN/� C�,"-D2D�Q/1� �/ ��/�f'/jj�(+ <br /> f� n^ Q /'lG � �.�� ---- -- <br /> ADDRESS�1��s��f,?�YYC.Q__���y�___ _CITY �K%/C"'P�ITELEPHONE �5��� <br /> HEREBY APPLIES FOR PERMISSION TO __�S.�'.__ �X lSy�j_/r'� _ f��/ y�L���( <br /> _ /- <br /> -- --- . _ - - -- ---- - <br /> ��n - --- - <br /> --- ---- - <br /> ATTHE FOLLOWING LOCATION I��_�AR�+i���j,�-/Y� i�UC,Q�/_�.� <br /> Attach five(5)copies of preNminary plans(or proposed work. Draw to scaie and show the following as applicable: <br /> • Property Iines and street identity. • Topographic ctianges requiring cuts and Nlla <br /> ' Outlfne and dimensions of existing and other than normal foundation. <br /> proposed structures. • On-site drainage systems when required. <br /> • Existing and proposed utilities. • Erosion control methods when requlred. <br /> • Centerline of abutting right o( way. • orth arro <br /> _L���� <br /> 9natura ol App icanl <br /> CONDITIONS: PUBLIC WO KS PERMIT <br /> T�e un,iersiqned owner hereby ap�ene lo holC enC eeve humisae <br /> Ihe Glq ol Evereu Irom eny ena eu ciaime lor Oam�pet, co�t�, <br /> e�peneea,or ceuaee ol action Ihe�mey�riee Dec�uee ol in�t�llsllon <br /> and mamler�nce of tne improvemenl or olher tlp�Dol�wey use <br /> �ere�o apphBA lor end lur��e!BprlB!�o rlmOVe um!upUn nO11C! <br /> ham Ine Cily entl lo re0�ece pu6lic property tl�mapetl t�sroby. <br /> � �'� � �f.�.—._.d_-�� z- � <br /> , OVEDFOR�;O TRUCTION DATE ACKNOWLEDGEMENTOFCONDITIONS -- . <br /> � � � � i <br /> � � I�� -y—_�`��= -���'. :xti �� �.[le4w�x.a/ S G, :PY <br /> __�R� � --�- -'`--- <br /> APP O�EQ �' TED DATE SIGNA�URE OFAPP -CANT DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR tNSPECTION <br /> JOBSITE 259-8811 <br /> � EXPIRATION 24HRS. BEFORECONSTRUCTION <br />