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r <br /> 1 <br /> ---- ----------I '7 <br /> -- — ------r---------- ---- --- �-- i <br /> �— � � � ; <br /> ' �'""�� APPLICATION FOR PUBLIC WORKS PERMIT <br /> �j � , Type or Gtlnt aie�dY wit�Ink <br /> � PRESS HAHD•YOU ARE MAKING COPIFS pERMIT NO.$�3 �, I <br /> i �I PUBLIC WORKS / BLDG. DEPT. N0. i � <br /> I EVERETT,WASHINGTON /�— /5'=_� I <br /> I p OWNER D AGENT DATE L 1 � i <br /> '/� / _� �_��.S T e r----- �i <br /> APPLICANT/FIRM REPRESENTED �--. --- ` <br /> � � y/ Y� CITY< vCY _TELEPHONE.7C- ?� C��S-s��- � <br /> , � �� l'�s�,�d�v <br /> ADDRESS _.--. � ��,, � �Am� � y I <br /> HEREBY APPUES FOR PERMISSION TO v� � �/ �, �� ��� <br /> i , , yr� . erl s �1-- !�-rZ ��= >/ /l„-�i 7�r ti/Q '1 i <br /> � �e�1�"��_--�" � -- �. <br /> i �_O�c,__�FSca � e�r , �� , <br /> � AT THE FOLLOWINO LOCATION , <br /> i Attach flve(5)copies of preliminery plena for proposed work Draw to scale and show the following es epplicable: i <br /> i • Topoyraphic changes requiring cuts end filla <br /> I • Property Iines end street Identity. other than normel foundatlon. I <br /> i • • Outline and dlmenaiona oi existing end . On•site drainege systems when required. <br /> proposed structures. • Erosion contro� mothoda when required. I <br /> �' ` Existinq ond proposed ulflitiea • Nortlyerrow J ,': <br /> I •CenlerlinF of ebutting right of way. �, , � � � <br /> �� . � 6G✓� � <br /> �� SlqneWre �PPllcenl <br /> I PUBLIC WORKS PERMIT i <br /> j <br /> I CONDITIONS: <br /> f� CO�'1C f.n,V1�[r� Nv��[/ �f� vt Ww <br /> I�� � � . , � � . . � . IY13�'�1,�1 fo�Qt Ov�' bq,p�lo}, dr,...nwSt� 3�/a�t . <br /> QNd� �Q a. �F � <br /> � . ; ; : . . • 0. n�c � �w^ y _ ,� , �� <br /> . � . : �o.. o!- y-l+: dn„c �.�.�.� w� �� <br /> i �• : •_ . a , `T�c��d?ow. w� ws� to� r�a„ � I <br /> ii 1 _1 -#"IIIIr�` OT G7fQ 1HP (�t SWA�C <br /> � ,� . . � 3. �n -.�Ni�4e/ a.l}e(^�o., ,o� I�Hd. 1s a.11GwcW. . . � <br /> . � � � � Al�.y�� NOf�'b'/1� V <br /> � � + . . . . - . . . � ' � /� . <br /> ...1_.. .. � [� <br /> j : : : aa�c�oN.\ed c..�r�.u�4- o� �P ,ca•• d t . . . <br /> '� co.+a, ro..a <br /> 'I : ._. . . . . . . . . . 'I <br /> ' I � . . : . I <br /> I � -, : . . . . S^�'� • �, . I <br /> I � z���C� �n.�(v Z. v\.P.nl-2�/l < <br /> �� 4 : ; : _ . ; . . J ' l - T�e underni ed owne� Mroby ep ee lo hold and N�e h��mle�� I <br /> the C�ly ol E � It Irom eny ona II r.IHm� br d�m�poe, CON�. I <br /> e�pl11lB0.Of C�u es ol ecUon�hs� Y����a DeGui!0�INUIIHb� <br /> � � � end melnlenencs al Ihe Imprwem 1 a otMr rlqhtol•w�Y u�� <br /> � � � � - � �erelo aD7lied lor and lurlher�proe�lo ramove uma upon nolb� <br /> i . . . . . Imm ihe CItY end lo replece publk DropaAY d�m�pM Ih�nby. <br /> � , <br /> t_ � . . ,? .3-6'�—_ ,� e a. _ ' <br /> IROVED F C N TRUCTION DATE � . � �-/ <br /> i �� � � � <br /> i SIGNAI"U F APP ICA DATE <br /> � qppRO�'cD AS CONSTRUCTED DATE <br /> CpLL FOR INSPECTION <br /> I� PERMIT IS VALID FAR 1 YEAR ppgT ON 259•8H11 <br /> �- � JOBSITE 24HRS.BEFORECONSTRUCTIONT <br />� -- -- -- <br /> EXPIRATION __ - ------- - -- <br /> �- _ ------ <br /> - — <br /> --- --— -- <br /> � � <br />