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u <br />� <br />r , <br />eV� APPLICATION FOR PUBLIC WORKS PERMIT <br />Type o� pnnt Uearly wit� ink <br />PqESS HARD � YOU ARE MAhING COPIES <br />PUBLIC WORKS PERMIT NO. � � '����� <br />EVERETT, WqSHINGTON - - - <br />T�Q OWNER Cl AGENT DATE ),��. �--._, ' BLDG. DEPT. NO.. __ <br />i <br />APPLICANT/FIRM REPRESENTED � �� y,y_ � .f:� ; ��_ <br />ADDRESS.�'i�-"_.7__`r," i -� <br />- -- <br />._ ... ---- _ CITY �=r._�,r,. T> TELEPHONE : '/i�-.: <br />- , t',.=, . <br />HEREBYAPpLIi'S FOR PERMIFSION TO ,��L/!'=__�;, <.- ,, ,,.,,. �2.,��_ � <br />� '- - -. . .. -- . ° �.=�,c _, <br />/,+'�i,i' .-__ - <br />AT THE FOLLOWING LOCATION „�%_`_ �'F r7',ti "T <br />ri...,f., - 7';• i...c - <br />. . . . _i _. - � ___.ti^Ly_/�, <br />Attach five (5) copies oi prelirninary plans for proposed work. Draw to scale and show thr: following as applicable: <br />' Property lines and streel identity. <br />' Outline and climensions o( existing and <br />proposed Structures. <br />• Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />CONDITIONS: <br />�–�.�'2'•'_- �(,/�` <br />_ i <br />/ c / <br />' .....��_ ....�� <br />' Topr,yraphic changes requiring cuts and fills <br />other than normal foundation. <br />' On•site drainage systems when required. <br />' Erosion control methods when required. <br />• ni....�. ..---... <br />SL�� • . � <br />(S ERMI <br />/til�!'�:-7— ��;� �/L�.' � <br />- - � Z � -%-C` Sz- <br />DATE <br />PERMIT IS VAL D FQR 1 YEAR <br />EXPI�RATION <br />f� <br />Tne um�erv9neA ownm hereGy agrees to �oltl entl eave hzrmlaee <br />mu Cdy o1 9verett Lan. any ano au ciaim� for demepee, w�te. <br />6apenie9. o' cause6 0l J��IOn IhB� m8y 81:ee EBCeule ol jpela11i11p0 <br />entl mxinlenanco ol I�e improvement or cl�er ri0h1•ol-wey u�e <br />herelo a�yhuA lor en� lurt�er epreea to remove e�me upon notice <br />Irom the Cily entl lo replace pu61¢ pwoerty demapeA ineroby. <br />OF CONDITiONS <br />POST ON CALL FOR INSPECTION <br />JOBSITE 259-$811 <br />24 HRS. BEFORECON;iTRUCTION <br />0 <br />