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r <br /> r- _ ..__-..-..-------� <br /> evercn <br /> � APPLICATION FOR F�UBLIC WaRKS PERMIT <br /> Type or ptlnl clearly wnM InF <br /> PRESS HAqD•YOU ARE MAKIN6 COPIES <br /> PUBLIC WORKS PERMIT NO. �_l/�` � <br /> EVERETf,WASHINGTON <br /> ❑ OWNER ❑ AGENT DATE L� °•� `� r � BLOG. DEPT. NO.g�as6�' <br /> L: �� " . .. - <br /> _ ,. _ ��y o <br /> APPLICANT/FIRM REPRESENTED _ _��?�-t�C L� .��� ( t- <br /> /i _ <br /> ��� <br /> ADDRE3S � , �:,' �lo.t��_sl _ CITY �c�a t _ _ -- -- <br /> / TELEPHONE .>r 7.l�i)) / <br /> HEREBYAPPLIES FOR PERMISSION TO _Ct��t'J t'< '� 'k' �+ , J � � ` .� If _C , <br /> . ( ' i � �/ -c C� ! �LL' �t <br /> .._`�!"�?=�=='��7�r-_Ja-- _. <br /> i <br /> � / — <br /> AT THE FOLLOWING LOCATION =^.i .�. C` .!1 Hc� <br /> Attach five(5)coples of preliminary plans for proposed work Draw to scale and show the lollowing as applicable: <br /> • Property 1(nes and street fdentity. • Topographic changes requiring cuts and fills <br /> ' OutBne and dimensions of existing and other than normal foundation. <br /> proposed structures. • On-site drainage systems when required. <br /> ' Existing and proposed u!ilities. • Erosion control methods when required. <br /> ' CenterHne of abutting right ef way. ' North arrow <br /> a _ <br /> � � <br /> _z�r�-�nt- �-- <br /> 51 re of Aou�kent <br /> PUBLIC WORKS PERMIT <br /> CONDIT�ONS: <br /> � . � . , . . ; , ; . . . ; . <br /> , . . , � . . . . <br /> . . . . . . 1 . . . . . <br /> � ._:_. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> � . . . . � . . . . , . . . <br /> . . . . . . , � . . � . . . . . . . ; . <br /> . . , . . . . . , . . . .._._ _j_� �.� . .� : . <br /> i . . . . . . <br /> , , � � The undars�gne0 own��r hereby epreee lo �oltl enA eeve �ermlase <br /> , , ihe Clty ol Evere�l Pom Bny antl all Clelme lor tlemep6a, CGete, <br /> . . . . . , eioeneea or caueen ol ecllon Inu:may erlse beuuee ol lnetellat�on <br /> . � and meintenence ol ths Improv�mnnt or ot�er rlphbobwey we <br /> � hereto epplled lor anA lutlher eprres to�emove�ame upon notics <br /> Irom Ihe Clty end b repleca p�.bllc propehy Aemeped I�eroDy. <br /> ��—i ,— . -'".! �__-}�h �>Z_. <br /> E OR ONST UC 10 DATE7 ACKNOWLEDGE�,ICNT CI� CONDITIONS <br /> / { <br /> � � / ��z S� 'N�UR�FAP .CAN� ' ) •'� _ �. <br /> APPROVED AS CON 7A TED DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTI N <br /> POST ON 259-8811 <br /> EXPIRATION JOBSITE 24HRS. 8EFORECONSTRUCTION � <br /> L <br /> O <br />