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�. <br /> everctt qppLICATION FOR PUBLIC WORKS PERMIT <br /> � Tvpe or orinrciauiy wuh ink �j' / --- <br /> PFESS HARD-YOU ARE MAKING COPIES pEqM1T NO. p=/_�-�— <br /> PUBLIC WORKS � <br /> EVERETT.WASHINGTON / , � P! DG �)[:PT. �JO. ' <br /> �, 1 OWNFf� ' Ac;CNT Dr11L y J � � G i <br /> �/../. <br /> APPLICnNT/FIRMREPRES[NTED ,(��� �! ���c/ <br /> ADDRESS _ . _ TELEVHnNES�?"�Y'�� <br /> p � Y� G�u�.../���u-- -��,Y - <br /> HEREBY APPUES FOR PERMISSION TO .�� ��—����—y��-�S-- <br /> ----- .. _ — ---- --------- ----- -- <br /> AT THE FOLLOWING LOCATION �L� n � �A�G���"�"—•---- ----- - <br /> Attach five(5)copies o(preliminary plans for proposed work Draw to scale and show the(ollowfng as applicable: <br /> � Property lines and street Identity. • Topographic changes requiring cuts and fills <br /> • Outline and dimensions of existing and . pn•shte drainege systems when raquired. <br /> proposed structures. <br /> • Existing and proposed utilities. • Erosion controt methods when requfred. <br /> ' Centerline of abutting right of way. ' North arrow — <br /> i'/lt�,.� � �c.-' . <br /> 7 3lpnature ol Rppllunl <br /> PUBLIC WORKS PERMIT <br /> CONQITIONS; _ . . . . _ . . . - - <br /> . � � ,J'TiF', .� . f T�. �B� c`'fT. 4��c�,� cF �'�'T. , . . <br /> : p. , �,.;y, �< .-,�. � r_ <br /> : . . . . . d_F..�3C:;.P %°T . /,'<c �/n9r�1` . �Jrt.f i S�-'/'f:l'.Fs'Ji.>� A•t'!� . . . . . <br /> ... . . . � Sv.!'c�:T. .!'�c��l9i✓iNG.. �fffi�,T7- f�r«r,F'. ./riJ' 4i?:l:T��tp - Gl'y i ff� . - . . <br /> . . � � . . �/9LI�SY(k' l✓c?.�'�l� . . � � � . <br /> ' ..�� ���lCG!!✓. _ :�F' ft« . .t�' . .<i�liT.nc+ ;Td . ir'/'lNc�� . F'G.�. . . <br /> ` . c�����. /t.r�7fi0. 4��'� !�l°i.J �.Co✓�'f>;; F'(cL i�('.i1yj, . <br /> i i ' � ��`1�. � � <br /> � � 'dT/f=JQ . sftjli!C'c_cPi ,�J/�c , �,'<t�iii�'F � �N A/'�f-�c�jlcT� /�+iC. <br /> � ��._a--• '� ./L��J ; %'�,�'n%/7' s�.i�ci/`�C ,�<rc:v.f'i°.:—..•�l 'd� '�JoiJ - � <br /> � � . . .JYGnJiF/C,/l/tC� C- . . . . . . . ' . . . . . . . . . . . . . . _ __. . _ . <br /> , ,ji . f/< F Gi�jt:� c�'� . �'�-�Sl'ii✓Ii�� 7c� �.�c�9 /�/3FI��rJ . . <br /> C J �, iJ �`z-�.�_=S <br /> ' �3'y� . i<'��.�' . ./ri4ii T. . c_ . 7. . . <br /> _; .�i . : .�},j��ti� . G,:C��� . �;�.�. ;�� ,P�=�s'�cv�> i��.��i�''Ss' <br /> /}y� �c. i 'c. c ��F.� <br /> -�-+---e - ��+'�'�l�-� '�l��� �-� v � � iha unAer6ipned owner hereby eprae� lo�oIE end eave hermlese <br /> ,T) . . ,F`��+,�j F,p �j,C,� Ld/c�. F�� tne Gry ol Evemll iro�n �nv ana eu cwm� lor d�m�pe�. co�t�, <br /> S,•� W���y �/'�,f{)'%/�'� 9`� eFDeneee,or ceu�ee ol ecllon Ihal mey ube beceu�e o11n�tN��bn <br /> ' ' � ' ' '�9G�'`"v end melnlen�nce of Ihe Improvement or olhe• Aph4obwq u�e <br /> _ . . . . ..rt2-yFScT19.f��' /St5'� C'7c3�=��'/�fJ/✓�� <br /> � . 1 , �a i�`�,�-�, �-.��, hnrola epplied lor end further �Oroee to remove ums upon nolles <br /> �a�y /'riCA'!-!c Gv� ..�iS� Imm Ine Cny end 10 reolece Dubllc propeNy d�mped Ih�reby. <br /> I!4 iC�.C3�'-+�ci�j/���/� . �O/�/�7�i�C /17'�!i J'<i�c=.f .4�J� ��c" :!-il�iyf//i"�'�ilJ 6'/ <br /> ` ��'��� ���;_� _ 6�0� �G!lfit� CJ�•,l��J //4lC/�'^�.�_,X".� .I <br /> �'" � -- � A OWLEOGEMENT OF CONDITIONS <br /> A ROVEO FOR CONS RUCTt N DATE • <br /> . -��� Y <br /> APPRO--�—VED A i CONSTRUCTED DATE L i IGNATURE OF APP CANT DATE <br /> FERMIT IS VALID� CALL FOR INSPECTION <br /> �;_ c�n�r/c POST ON 2591•8E311 <br /> EXPIRATI(�N � 7- 6 ' '9"z JOBSITE 24HRS. BEFORECONSTRVCTION � <br /> _.._. .� <br />