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'i <br /> � <br /> "'�'"` APPLICATION FOR PUBLIC WORKS PERMIT <br /> � Typa or Drint elearly with Ink <br /> PRE55 HARD•YOU ARE MAKIN6 COPIES pERM1T NO. �SL— <br /> PUBLIC W017KS � <br /> EVEREIT,WASHINGTON /�= BLDG. DEPT. NO. /O`/G 3 � <br /> �}�'OWNER ❑ AGENT DATE �_ :— <br /> �4PPLICANT/FIRM REPRESENTED _�7LRd�—_�19-3i1+1�� <br /> ADDRESS Z5 31 C�E'b�l u� CITY �Y—�'-.�-It TELEPHONE7 S� Z sI�(oL! <br /> HEREBY TO I��� a►� ��X Zo� �44.n1 To NoRTI� <br /> � Z <br /> ATTHE FOLLOWING LOCATION <br /> Attach five(5)copies of preliminary plana for proposed work Draw to scale and show the following as applicable: <br /> • Property Iines end street Identity. ` Topographic chenges requiring cute and fllls <br /> " Uucline end dimenslons of existing and other then narmel touridation. <br /> proposed structures. • On•sfte drainagp oystema when required. <br /> � Exlatl.ig and proposed utflities. • lon control methods Nhen required. <br /> • Centerline oi abulting right of way. • o arrow <br /> Sipnamre ol ppucanl � <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS; . � <br /> I . . . . . . � � . . . . : . . : . . <br /> , , , <br /> �I . - <br /> l : :_ : : :�<�'S! : :f1/�>i,'�lc�'f- ��;�,✓� :r? . ..T,t��- .�.�.�:;� ���f,�.�i'� �9:�dt�. . <br /> ` . . , . -" .1�2'� //I�Ci . C�_'/lI�('Ti�CI� i/ S� n� K '/< <-. ✓S'c , <br /> . C.C(7%.. !C.. . /� <br /> � . , . � �r Cryr lFlfi'C L4l � !' (C� /n1J'�!< T_,�`�. . . . . , <br /> . . . . . . /(�`J./'/�E'. . . �`.-. . �f' <br /> „S��%-i�y�rfi4 Ti�-�n) .. ; ; <br /> i . . . . .. . .. . . . . . . <br /> f . . . . . . . . . . " ' � � . . ; ' . . . . . . . . , . <br /> � ! � <br /> � , ,__. , <br /> ; . ._._. . _ . � . .._._� .._....t- .... . _ _ <br /> , . . . , - . . 1 ; � i ; ; . � . . . . . : . � . <br /> � . . . . . . � , , <br /> � . . . . 1 . . . . . . . . . . . . . . . <br /> . . . ._r -• •- '-'-�..� -- '_'--t-��.. . <br /> :`�'"'-'-� } .�� � Tne underelqnad owner hereby apreee lo hold end s�ve hermleee <br /> i � � , . I � � ihe Cliy ol cvereli Irom eny antl nll Cl�lm� lor A�m�pl�, cON0. <br /> e.penena,or rewes ol ectbn Ih�t moy arlse bec�uss W In�ldl�llon <br /> ' � ond melnlenence ul the Imp�wement or other riphl�o4w�y usc <br /> ' ' � � ' � � � � hereto eOV��ed lo� end lurlher e0ree+lo remove��ma uoon notice <br /> � � � � . � Irom the Ciry nnd to �eplece Oublk D�opsrtY dem�ped ��aro6y. <br /> ', . . . . , , � .. <br /> ' `�' i �. r. �—. <br /> i '��f'i7�� �..�1 <br /> A OV '/�OR CO S / TION `, DATE A NOWLE EM OF CONDITIONS <br /> � -�,��r��. � _ z�- <br /> APPROVED S CONS CTED DATE SIQ ATLIRE APPL ANT D TE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOH INSPECTION <br /> POST ON 25g-8811 <br /> � EXPIRATION '� - ' � ��'' ��Bs�TE 24 HRS. BEFORE CONSTRUCTION ' <br />