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.` <br /> everett Af'PLICATION FOR PUBLIC WORKS PERMIT <br /> � TYGe or Print cl s�AY wllh Ink �/s <br /> PRESS HARD•YOU AflE MAKINQ COPIES pERM1T NO. �!�" <br /> PUBLIC WORKS � � <br /> EV[RETT,WASHINGTON BLDG. DEPT. NO.— _ <br /> ❑ OWNER f3(AGENT DATE �—�'.�����'-_--- - ., � <br /> �,.,�_ - `il > � <br /> APf'LICANT/FIRMREPRESENTED ��—�L�!� E�I���SL�/(' -`—�-���sG• ���� <br /> ADDRESS _�yr•� S���'� ��� CITY r— � � TELEPHONE_--- <br /> HERF.BY APPUES FOR ?ERMISSION TO _�.`�� l/�nn��".�%+ rn—,�T��- <br /> _.���-��-�----��-�-��-�+ - <br /> AT THE FOLLOWING LOCATION <br /> ���Z <br /> Attach five(5)conios of praliminary plans for proposad work Dr�w�ale�nd show the lollowi�g as applicable: <br /> P � <br /> ` Property Iines end street identity. • Topogra�9�oh�q���ig cuts and (flls <br /> • Uutline and dimensions of existin{7 and other than normall� ndat�c�n. <br /> proposed structures. • On-site drainage systems when required. <br /> • Existing and proposed utllilies. " Erosion��bntrol methods when required. <br /> ` Centerline of abutHng right ot way. • Nort,h'a fow. �/ <br /> � ��/��_<� � <br /> __ _ _ SlpnalureolAp ticenl <br /> �UBLdC WORKS� PERMIT <br /> CONpIT�ON.s; . �G'G-:. <br /> i. � <br /> i : : : �-i�;'"�/C'"��iT=�'. : �'�"�'��'!v � /�c',>l//."/� O�' /, L=� ' <br /> , . . . <br /> ; <br /> ' : : : : ' ; . . . ; . : . . . . . . 7-��c��(, �,Gc� <br /> ' :_: � : �_ . : _ ._:_: . .:_ _ .... . : : . : . . . . . . . : . . . . . : . . <br /> C . .. .-_ .1.'��: <br /> . . . , . . . . . . . . . , /�/�� . . . . . <br /> , . . . . . �..- <br /> � . . , . . : : :I�� . 7,�vr Pu9N Lop4s' e�..0 7n �rt- .t�o �,r� rD s.�r 7�J'Es•►�pd.�r.tt+dwr <br /> � . . . . . . . . y�. tlr►,f��x�E :eE+�,Kd er�.5�sw✓Esw.� p�t"�'Tn t�ui,e eE,s+�fr/� - - : - : . . <br /> _ ,_._.._.: . : : xr o,��y r�.f6EJilo�/' wu�d BE 7h�1T- �E iMAv49•��1' s7Xe�✓6c y �tliOF� . <br /> . : : . . . . NA,[A Sd�A4�� ��4!'/hh!'c7" Of TNE �%�'1Y .�o✓RT���4.d� Ta HAKE. i7 h�RE <br /> .. '-. . . , f�l!�/e�l�.V/jL. SoNE �4Y 2�ve'/Wf"J� IrJDdLl�'.4LSOM�1'f 7Jril/h154 :�+aQ�' <br /> . . . F'�.vcJTD.c//FL. �-��� <br /> � ' '�"-'� ' ' � - � � ` �y T�e undcrsipnad owner hereby eproes to�o�d end aave hermloas <br /> � � � � � � - � ��,l�hO�nJ 1,V/�, Iha Clly ol F.,rrll nom �ny ana au clelme lo� dem�pea costs, <br /> � . . . . <br /> _ , . . . . - �-� � urponne4 er ceunea ol acllan I�al mey erlee betwee 01 Installatton <br /> . . . . . . . . . . . . . end melnlanenco oi t�e Improvemanl or olhar d0���oFw�y u�e <br /> . . . . . . . . . . . . . . . . . . . � - � �emlo app��ed br end lutlne� epreee lo remove eeme upon not,�+ <br /> � . . . . . . . . . . . . . . . � � Irom Iha Clty and to �eplaca publlc pmpsrtY dem�ped Ihsrsby. <br /> APPF VEO FOR CONSTRUCTION DATE ACKNOWLED6EMENT OF CONDITIONS I <br /> APPROVEDASCONSTRUCTED DATE SIGNATUREOFAPPLICANT DATE � <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> PO�'P OP! 2��9-8811 <br /> EXPIRATION JOB:aITE 24 HRS. BEFORE CONSTRUCTIQN i <br />