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�re" pppLICATION FOR PUBLIC WORKS PERMI�' <br />� TYGe or PriM clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EJERETT, WASHINGTON <br />�OWNER ❑ AGENT DATE AUGUS7 16, 1 962 <br />PERMIT NO. ���'s�� <br />BLDG. DEPT. NO. 82f10882 <br />qpp�,ICANI'/FIRM REPRESENTED YOU. H120j_ HUOtII __ . _ . - - - --- ---�--- - <br />ADDRESS_ —839_NE_NOr.ingaie_Ylay__.___.—_— CI7v _Sedttle____TELEPHONE 363-0380 <br />HEREBY APPLIES FOR PERMISSION TO _COIIVEr'LStCllCtuL'�YO__DO011t�hOp_USe_ <br />ATTHE FOLLOWING LOCATION __— _2515_B�oadway - ---- <br />Attach tive (5) copies of preliminary plans tur Froposed work. Draw to scale an� show the following as applicable: <br />• Property lines and street identity. <br />" OuUine and Aimension^ of existing and <br />proposed structures. <br />' Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />COt�71TIONS: <br />BLI <br />` Topographic chsnges requiring cuts and (ills <br />other than nori�al foundation. <br />• On-site drainage sy�tems when required. <br />" Erosion control methods when requi�ed( ,� <br />` North a!row �•� \ <br />� � a�/� . �, <br />You Hien Huoth_ —.�� — -� <br />---. .. s�q��io.e oi nonow�i _L <br />� • ' <br />� <br />� u�����, ����� <br />� � <br />/ - <br />i <br />DATE <br />PERMIT IS VALiD FOR 1 YEAR <br />EXPIRATION <br />� <br />The undersigned owner hereCy agrees to hola and Seve hermlesb <br />ihE Gily 01 Evyre�t M1om eny an0 all CIB�mS �or tlamegCs, Co8�6. <br />e�De�ses, or causes ol aclion thal may anse beceusa ol installetion <br />entl mainlbnanCe of ihe Improvemenl or olher nphl-o.�wBy Uee <br />�erelo apvlied lor an0 lurther agrees to remo�e seme upon nolice <br />lrom the Cily and to replece publ�c n�oneny demeged thereby. <br />/C ; � � � ACKNO:NL E GI <br />SIGNAT� <br />POST QN <br />JOBSITE 24 H <br />:L FOR INSPECTION <br />259-8811 <br />BEFOPECANSTRUC110N <br />