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1 <br /> �"'°'�" APPLICATION FOR PUBLIC WORKS PEFiMIT '� <br /> TYPe w Print deerly wilh Ink ^� .. —r,. <br /> PRESS HARO - VOU AqE MAKING COPIES AERMIT NO. _ � � � '�-� <br /> PUBLIC WORKS - --- <br /> EVERETf,WASHINGTON , BLDG. DEPT. NO.__ � <br /> ❑ OWNER ❑ AGENT DATE �_ � L � � <br /> APPLICANT/FIRM REPRESENTFD N I� �L�'4�" ,. � �� � t. <br /> ADDFlESS _�---�L�.'c-�����=--- —CITY ` ` �� � ��--_TELEPHONE_ _ � )�• ;` <br /> HEREBYAPPLIESFORPERMISSION TO �'''r + 'a 'i i _�_����•___'. �� � � /,.�i <br /> � . i-- * <br /> AT TNE FOLLOWING LOCATION ______�_' __ _ __i �� 4�[ _ _ _ <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show ihe following as applicable: <br /> ' Property lines and street identity. • Topographic changes roquiring cuts and fills <br /> ' Outline end dimensions of existing and other ihan normal toundation. <br /> proposed structures. ' On•site drainage systems when required. <br /> • Existing and proposed utilities. • Erosion contiol methods when required. <br /> ' CentFrline of abutting right of way. • North arrow <br /> i� <br /> �__�' j .� j � <br /> . __ �_ _ ._Signerme oi Aoalicanl --- <br /> PUBLIC WORKS PERIVIlS' <br /> CONDITIONS: <br /> � �,. y <br /> Existi�q lqater llaln �t this prop.�rtv 15�not ac'equate t0 FP��r this projuct. <br /> I)evclopnr h.a� t��•o ontl�ns `�r,��rr �vater �ervir� r.an hr ataSl!sh.-r'i <br /> i <br /> 1. f?xtend F" uate' in�ln northnrlv from existlnv, Cn�' polnt approxl;n3tely <br /> �+0' south nf propertv hnr [a a mfnirum of 5' iosid� thl� pmpertv line, <br /> nr, <br /> 2. Tn •��alt untll itter the Clty r�pl�c�s the �xisting �vate� main with a <br /> . . . . . new� ,�� maln latqr this Year. <br /> . . . . . . . . . , <br /> � lhe unAervgned ownor hereby nB�ees lo holA end sere harmlaae <br /> Ihe Cily ol Evefelt Irom eny 0n0 ell ClBlme IOI OemeOee, cowte, <br /> e.penses,ar causen ol eclion I�al mey eriee becauee ol Inatellallon <br /> and memlenance ol Ihe improvemenl or otAer rlpN•ol-wey une <br /> horelo epplied lor entl lurl�er egreee lo remova nams upon nollce <br /> Irom �hn Cl�y enE lo re0lece public properly dcm�QeE Iheroby. <br />. .. . . , ' .,_ ._. <br /> i <br /> AP�RO EDl CON�STRUCTION � - --� � �DATF - ����- ACKNOWLEDGEMENT OF CONDITIONS _ <br /> > ` "��/(2 t / i. r / .. <br /> L I CJ �/ <br /> I APP OVEDASCONST UC ED� � DATE SIGNATUREOFAPPLICANT DATE � i <br />� PERMIT IS VAi.ID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> JOBSITE 259-8811 i <br /> IEXPIRATION - � � _ 24HRS. BEFORECONSTRUCTION <br />