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p <br />,�l aPPLII;A'..ON FOR PUBLIC WOI_.:S PERMIT <br />'G) PRESS HARD �rY0�1 ARE MAKING COPIES � <br />PU6LIC WOFiKS PERMIT NO. �^�__ <br />EVERLTT, WASHINGTON B�DG. DEPT. NO. <br />O ONlNER �CAGEN? DATE _���Q]_�_I`�QtZ_ <br />APPLICANT/FIRM REPRESENTED __C—�GY—��_�tJ`aT�-ILC.TlOr�. ��aG___ _____..__ _ __ <br />ADDRESS t:= � ' ��1�-wC"�1=__ _C�Ty E.�iOiJIY TELEPHONE �77,5�'4FZ'; <br />HEREBI' APPLIES FOR PERIv11SSION TO <br />ATTHE FOLLOWING LOCATION _�g��� __Lt�L��Y�S�_L(\tl.t:.—�`__���:k�=1C ��_ ____ <br />J <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the follo�ving as applicable: <br />' Property lines and street identity. • Topographic, changes requirina cuts and filis <br />• Outline and dimensions of existing and other than normal found.iion. <br />proposed structures. " On•site drainage syster.,s when required. <br />" Existing and propused utilities. • Erosion control methods when required. <br />` Centerline of abutting right of way. • North arrow <br />---'����_LfC- r � • L� �� .��sck- <br />SiOnelure nl Applicnnl <br />PUBLIC WORKS PCRMIT <br />CONDITIONS: <br />,... /. <br />�d /�(f�C% <br />� <br />..... �. . <br />. . i.. ' . . . . � . . <br />. . . : 1 . . . . . . . <br />�,A.' <br />, ��[3 c i G <br />1 <br />/ ' <br />G.. '' '-___J <br />ihe urcersigncU owner hereby agrres lo hold entl save harmloss <br />Ihe Ciq• ol Ererntt bom any ena uu elnims lor damayes, eoslr, <br />erpensen, ar causes ol actiun Ihal mey edse because ol In6telletlon <br />and mainlenence ol t�e improvemont or o�her rlpM-ol�way uae <br />herolo applind lor and �ur�her eB�eea Ic remrne eama u0on nolica <br />Irom Iho Clty antl lo replace public pmpetly damepeE Ihe�aby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />c0 Q/cP Z— — <br />. SIGNATUREOFAPPLICANT DATE _ <br />PERMIT IS VALID �'UR,1 YEAR ! I CAL� FOR INSPECTION <br />POST ON 2�9•8811 <br />EXPIRATIUN `j `� "�� I JOBSITE I 2qHRS.BEFORECONSTRUCTION i <br />a <br />