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r <br /> °""'n APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Prinl cleerly wlth ink / <br /> PRESS HARD-VOU ARE MAKING COPIES pERMIT NO. 4���( `� I 2- <br /> PUBLIC WORKS <br /> EVERETf,WASHINGTON BLOG. DEPT. NO._. _-_ � <br /> i <br /> fE,OWNER ❑ AGENT DATE 7�l b:� _- - <br /> APPLICANT/FIRM REPRESENTEO I�jA'�od �. L-�� r r �� <br /> ADDRESS �1L��:1'-t"�'�=���- _CITY .�11•�t /f__TELEPHONE "-���' -i "-S y�y' <br /> �'� / / _ <br /> HEREBY APPLIES FOR PERMISSION TO �'�� y «ir1.Js----_d. r i_r.i__L�.c'� _ <br /> J' <br /> � <br /> ATTHEFOLLOWINGLOCATION LL/_9_Cst�1���-._�_ ��'�� �1����.--`���'--3 — <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> • Property Ifnes and street identity. ' Topographic changes requiring cuts end (flls <br /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> • Existfng end proposed utllities. ' Erosion control methods when requlred. <br /> • Centerline of abutting right of way. ' North arrow <br /> ��� >r.� 1 _o�ollcanl ---- <br /> coN�irioNs: PUBLIC WORKS PERMIT <br /> . � ._: . .. . . , _. . . . _ ._. . . _ _ . . i .. . <br /> i <br /> � . � , � iiii _ � I � ,_,. <br /> � 1 � , <br /> .._I.. . '�. <br /> :.�_�: <br /> � . , <br /> .�..� . ., �.. <br /> �--�.�_;_.�.� , <br /> l -�- i � <br /> I <br /> The undereiqnee owner heroby eqreee lo hol0 en0 ewe �umisu <br /> tne Cuv cl Evarell trom �ny ena ui clum� lor d�m�pa�, coslR <br /> eapeneee.cr caunee ol ecllon Ihe�may�rise bsuu�e d In�ldl�lbn <br /> end meinlar.ence ol I�e ImOrovement or othar rlphlrol�w�Y u�a <br /> herelo epo��ed lor ena lurl�er epree� lo ramove Nma upon nolks <br /> � Iram tne Clty and to replsce Oublic propetly d�m�paE IhneOy. <br /> ' � . ���,(F� ___T/1 � <br /> � / <br /> A E � ONSTRUCTION DA7E:' � � ;� ACKNOWLEDfiEMENTOF NDITIONS . _. .i <br /> � � r <br /> 1 Q. �- ��lc=�-����— �— <br /> A O til . NST UC j � DAT SIGNATUREOFAPPI.ICANT ---� <br /> PERMIT IS VALI OR 1 YEAR pOST ON CAL.L FOR INSPECTION <br /> 259-8811 <br /> EXPIRATION JOSSITE 24HRS. BEFORECOIVSTRUCT�ON <br />