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everett APPLICA'� �ON FOR PUBLIC W�� .rCS PERMIpT
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<br /> PR[SS HARD- YOU ARE MAKING COFIES pERMIT NO. �. _ ...
<br /> PU81_IC WORKS �
<br /> EVERETf, WASFIINGION BLDG. DEPT. NO. ___ . . . �
<br /> LI OWNEH �AGENT DATE j-�G• ��'Y
<br /> APPLICANT/fIRM REPRESENTED ��7E['Lf� //G'tc17� CC�'lob�li497t1�. c� � �u"6r�S`�uND
<br /> ADDRESS ��/ cSl� /Cv� ST. CITY /�NTbN TELEPh�ONE !�_����7Y
<br /> H[REBY APPLiES FOH PERMISSION TO C�CSG �'�XhS���Ys'_ OY'i (J'GLJ�s_ � , I-���'����,��
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<br /> ATTHEFOLLOWINGLOCATION /T CRSil� !�d �����-- - Ja �'i� — - -
<br /> Attach tive(5)copies of preliminary N'ans for proposed work.Draw to scale and show the following as applicable:
<br /> • Property line: and street ider'�ty ' Topograpnic changes requiring cuts and fills
<br /> ' Outline and dimNnsions of existiny and other than normal foundation.
<br /> proposed structures. ' On-site drainage systems wh.an required.
<br /> • Existing and proposed utilities. • Erosion control methods whE�i required.
<br /> • Centeriine ol abutting right of way. ' North rrow
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<br /> APPROV[D �O NSTRUC ION DATF ACKNOWLEDGEMENT OF GONDITIONS
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<br /> APPROVEDASCONSTRUCT(iD DATE SIGNATUREOFAPPLICANT - DATE
<br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION
<br /> 259-8811
<br /> E)�PIRATION -__ _ .10BSITE 24HRS. BEFORECONSTRUCTION
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