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�` APPLICATION FOR PUBLIC WORKS PERMIT <br />� TY7e or Print elearly wlt� Ink ,' /7 '� <br />PRES3 HARD • VOU ARE MAKIN6 COPIES pERMIT NO. _-f� ��L <br />PUBLIC WORKS / <br />EVERETf, WASHINGTON ;�: -3 � q �� <br />�I�OWNER ❑AGENT DATE,. �' � <br />Siue.n�r� N+�_'a <br />APPi.ICANT/FIRM REPRESENTED �— <br />BLDG. DEPT. NO. <br />ADDRESS k I <br />� �� �G�'�'6N/RP t7Ti' _CITY FUR+�T� TELEPHONE_ <br />HEREBY APPLIES FOR PERMISSION TO �'�����-� cr-_ .4 F�� �ALT U,Pr v r- �QY <br />673.1 B�rinsi�r-�v_, D/r./_v�fi'r-_77 w.4. 9�zb3 <br />ATTHE FOLLOWINCi LOCATION _ – — <br />Attach five (5) copies of preliminary pl�ns for proposed work Draw to scale and shaw the following as applicable: <br />• Property Iines and street fdentity. <br />' Outline end dimenaions of existing and <br />propoaed atructures. <br />• Existing and proposed utilitles. <br />• Centerline af abuttfng rfght o� way. <br />' Topographic changes requiring cuts and Iills <br />other than normal foundation. <br />• On-site dreinage systems when requlred. <br />• Erosion control methods when requlred. <br />• North arrowd . ' . e n <br />� <br />;9NPITIONS; <br />..; ...�,.......,.. ............ ......-_., ..... <br />� . � . . . . � . . . � . � . j • , .__.. __ . . . . . . , - . _ . ._ . _. � -, .-� , . . . <br />_ _�._ _.. ...____ . _ _1 "_; � . . . . . . . j . . . <br />-- _� �... .. .• .. ... i i ;.... <br />, .... , i <br />.. �..:f....� '...._._._j ._...., .. ._..;....... •;' ,. i �.;.. <br />.�...~ I•••j�..i......:� '...�.., .. .: , , .:..... •; . <br />�,..�..::._. :::�-.:-.-- <br />.. . � . ... <br />� : _: . :-- , � �.. _ � ____. _ �_. _ _ . ' , . ; � ' t � : <br />.:: �j ��; .: : , .:: <br />, a :.._ . ._� . . <br />__. ._. . , . . <br />. . • . . . • '' � . . . . . � . � . . . . . ' . . � GO N S � f NG� l O N � I"1'� ' 1J I1 I L� <br />.-. _..y._..�_....--. <br />`-� "r"�T"'i �� Tha unCerbi9�ed owner heroby eprees lo hold end �we narmtee� <br />� � � , , : . . t . � . � : • ' ' � ' � ' � 1�e Clty ol Everelt Iwm eny �no �ii culm� lor d�mo0e�. co�ts, <br />. . � � ; � ! • ' � ��: : ; � ; . � � e.ueniea or cause� of �cllon th�t moy �dse Deuwe ol In�t�i�Nlon <br />�...�.. ....... ......._�.... <br />an0 meln�en�nce ol Ihe Imprrnemant or othar rl0�t•o��w�Y usa <br />� � • � � ' ' " � ' ' � - � � herelo applleG lor end lurther eqrese lo remove ums upon notics <br />� � � � • � � ' � � . Imm t�a Ciry �n0 to �epl�ce Dubllc props�y d�mapeA Ihareby. <br />i . . <br />,-,_ �� � . /. <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />ACHNOWLED6EMENT OF CONDITIONS <br />�I SIGNATUHE OF APPLICANT DATE <br />CALL Fv1i �nar�a. � ��+�• <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />