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eVw APPLICATION FOR PUBLIC WORKS PERMIT <br />�/� <br />PUBLIC WORKS <br />Type or Prinl cloarly wilh Ink <br />PRESS HARD • YOU ARE MAKING COPIES �. j-�, � <br />PERMIT NO. � :_ i� <br />EVERFTf, WASHINGTON BLDG. DEPT. NO.—_ <br />❑ OVJNER Rl'AGENT DATE _ •__�^ ± �� �` �__ <br />APPLICANT/FIRM REPRESENTED �� ,=,•d_���' l�L�.�cJ_�_ �—_ I!<v: I.,_.� I";-------- <br />ADDFESS � � ' -i , 1 � • i � , �� :� ,�"�: ,q � CITY �' = h` �='t � TELEPHONE � ' l:i � <br />HEREBY APPLIES FOR PERMISSION TO �/ � � ` ��1 / � ' • r�` ��. � � --= ,. -% � � � �'� <br />ATTHE FOLIOWING LOCATION �' �� �'_ <br />. , , �. . �. <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />` Property lines and street identity. <br />` Outline and dimensions uf existing and <br />proposed structures. <br />• Existing and propnsed utilities. <br />* Centerline o( abutting right oF way. <br />CONL�ITIONS: <br />_ / % <br />���'r/9 � <br />�. <br />� <br />� Topographic changes requiring cuts and fills <br />other than normal foundation. <br />` On-site drainage systerns when required. <br />' Erosion control methods when required. <br />' North�arrow . " <br />, . � <br />RKS PERMIT <br />� <br />�G�'����,-�:<_/ <br />///�J' Z- <br />The unEersigned owner hereby aB�ees to holtl and save harmless <br />the Clly ol Everell trom anY ana an ciaims lor demegoa costs, <br />erpenses, or causes of acticn thet may a��se because ol lnetallation <br />and mainteuance ol the impmvnment or other riph4ol�way use <br />horalo applied for and lurther aB�ees lo �emove seme upon notice <br />Irom the Cily antl t� replaco public property demeped Ihereby. <br />CONDITIONS <br />PERMIT IS VA�Tb FOR 1 YEAR pOST ON CALL FOR INSPECTION <br />259•8811 <br />EXPIRATION ��/ � ' �-' JOBSITE 24HRS.13E�'OR�CONSTiiUCTION <br />� <br />