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�everett qppL:ICATION FOR PUfiLIC WORKS PE�MIT <br />TYOa or prinl c1e�dY wllA Ink � <br />PRESS HARD • YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. _ <br />E\�ERETT, WASHINGTON / <br />�j OWNER ❑ AGENT OATE ,A�� l�� (� �-i �% I"� BLD(3. DEPT. NO.. <br />APP!.ICANT/FIRM REPRl-'SENTtiD �?�`a "/�-'!-/Y7� l h/t�c.l <br />AODRESSi�'/.i ;; /:%F�l1Cc:N/fi'E_, �j�-, <br />CITY �r� 7� 7ELEPHONE <br />HERF_BY APPLIES F()q PE4A�ISSION TO <br />r- <br />ur- <br />AT iHE FOLLOWING LOCATION �' �•�•� �� h'k,s/r�rra [» ��,r-�,r T� u�� ��1�� � <br />Attnch five (5) copies o( preliminr.;y ai.�ns for proposed work Draw to scale and show the foilowinp as applica`�I +� <br />• Property Iines and street Iden :iry, <br />' Outline and dimensions of existing aed <br />proposed atructurea. <br />• Existinp and proposed utilit(A3. <br />° CBIlt9�line nf ahuxt,.,. .:..ti. ..• ..._.. <br />• Topographic changea requiring cuta and filla <br />other than normal foundation. <br />• On•site dretnage syatema when requfrod. <br />• Erosion control methoda when reeulrp� <br />. . . . . . ,.. . ..----�--- <br />. . � . . . . j . . . _--_-'_'_---�---'-' _- - � � � - � . . •-. . . � � - . ._ .-- <br />.. :...I.. ,';'I.... , <br />.. ,...i...� ...�.... i._.. . .....�.. . ....... <br />• .�• . • : • t • .._.�` _._ � r . . . •.. . i _ _ : . . . � . . . . . . . � . . . � . . . ; . . . . . . . � , . . ; . <br />. . . � . . �� . . � . . . I ___ ._�._'_.}" _"-� :"_"' .. . ' /l.I� - j . . .. �-. . . . . _ . .-. . . � _ . <br />ui ' - <br />_, � � �� � : . : . : _ � � : : : : : : : . - / �.�4 � �. : : : . : . : . . : : : : <br />._. ,...,.. ; .,..... , : . . ;'�� . . ,...:�: <br />. .�_:.��:�. ._. _^ I ' :, . . . . , . . . : : : : : : � : : . . . . . . <br />.. �_'_' .'- ____ � --.----- �--- ._..::..; ._.:�:;:_:.. <br />..,::-;---_'��.-r-.___ �_.:_.. . . ::... � • <br />.�.......;.... . ...... <br />.......:...:.......... . .. . <br />--- ' , � -_ � . :;_ _: �:��.__L;_ . ' <br />G:::::...._".�...,.... , -... . <br />� . � . . . � i'. . . . . _ . ' . . . .. . _.. : ' _ . . . . . <br />l. . . . . . . . . . . . . . . <br />APFqqV1ED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION- 7- Z%-gZ- <br />The unCenipneO owner Aeroby �prea� lo holA �ntl uv� h�rmleu <br />Ihs Gry ol Evsrett trom �ny �n0 �p cl�im� lor E�m�peS W�t�, <br />e.pema4 or c�up� ol �ctbn M�1 mq u1�s Eec�up ol In�INyiyn <br />�ntl m�ln�an�nce c! t�� ImDroramanl or olhsr rlpAt�ol-w�y u�a <br />�ereto �yDllad lar �ntl IurtAer �pres� to remow ��m� upon nollea <br />Irom t�s Ciry and to �eD��ts publb property d�m�q� IMreEy. <br />ACKNOWLEDIiEMENT OF CONDITfOAS <br />SIGNATUfiEOFAPPLICANT DATE -- <br />POST ON I CALL FOR INSPECTION <br />JOBSITE 259�8$� � <br />24 HRS. BEFORE CONSTRUCTION <br />