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r <br />i <br />, <br />L <br />L <br />� <br />' pPPLICATION FOR PUBLIC WORKS PERMIT ��/��� <br />� Ty� pr prlM cIe�AY wIU ink <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. � <br />PUBLIC WORKS BLDG. DEPT. NO.����— <br />EVERETT, WASHINGTOFS � ' � _ tl `� <br />�WNER ❑ AGENT DATE _�--�' p , <br />/Yi/1. . . � „�l, n,i , .GL _ D-�-GtC'E�L� <br />APPLICANT/FIRM REPRESENTED � ��""'-- <br />-. ., /./_ '�'�- <br />ADDRESS �=�- <br />HEREBY APPLIES FOR PERMISSIO�' `� <br />.� <br />NE �� �� �L•S/ <br />ye <br />AT THE FOLI OW�NG LOCATION .-- " � � Iicable: <br />Attach five (5) coP�es of preliminary plans for proposed work Draw to scale and show the followi�9 88 app <br />• Topogrephic change� requirinti cuts and fflls <br />� • property �ines end street identity. other than normal foundation• d <br />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />� Cente�line of abutting right of way. <br />�;-;i:': <br />,., ; t r : <br />� On-site drainage sYstems when require . <br />* Erosion control methods when required. <br />• NoRh arrew � v���2� <br />I y� �./ � �4 <br />'%�2'r^ti ��- 'aCl�l <br />giqnature ot Aao���^� <br />... .....__. .. �._ . _ _ . . _ . . . . � . . . . . . <br />_.._— ___ '_' . � . . . . . . � . . . ; . . . <br />..—_'_--' . . . . . . . . � <br />._ . . . . . . . . . <br />. � : � . . . . . . . � . . . . . . . . ' . . � . . . . . . 1 . . . : . . . I , : . : : �_-_i ._. . . . . <br />. <br />� , , . . ._. t . . • ' ._-. l . _ .- . . . . . � , i . . . � <br />. . : .._:.._ '_' .._ . . ..:.:..y._.. �-� . . . . . . . . . . • . . ' . . . ! . . . � . . . . . . . . <br />.` �4 <br />� <br />,. �.. i ::::..�.......�...::::I ::::............ �:.:. <br />, � � � . . . � - , _,__.---� <br />��..�: '_��; � ',-.-=-. �. �-1---:_.__�_ �----- ' ----� ; : { . ! . . : ' <br />11I .... 1 • . ; :'+..: j .'.`� �' � ; ��.' +�.�-- � <br />. � • � t ' i . . . . � . . � ' �Y� i _ . . . <br />,. ��1}.......__-�... .__:� t '�� 'f...�... t,. <br />r __..��--I_"—' . . . . . . . .. . 1 , . � � � . . . . . . . . . <br />1 '. : • � : : '. : : : f :�: : � : : : + : �• .. ' . � : ' : . : ` � : � :. �. �. � : : : : 1 • : : , : : . �. . . <br />; � � � ` �- � <br />.� L ._-�—__ _ <br />l._.. � --_ , j . . , , � <br />�:'7��.������4�-�. : <br />i' d owner hereby aprees to �ad ��d Hve herml�s � <br />� '_ . I' 1. �J � �, � ... `. . �. �. . �� �� ''- �" _' �' 1 � . ' _' �,_ '. . <br />�--������r- a L_ <br />�B _� : s- � <br />!� C <br />,��...,•-- <br />PERMIT IS VALID FOR 1 YEAR <br />!�/r= $3 <br />EXPIRAT�ON <br />The underaip�e <br />the CItY ol Everolt trom eny ana ��� culm� lor GmW�� <br />expense0. or uuses ol actlon t��t mry ��M �uw a��.Y u�� <br />and melnteoence ol l�e Imprrnemanl a ah�r rfp� <br />hereto �VDlled lor end IuA�er �proas to r�mova um� upo;n� � <br />Irom Ihe Ciry end to reD���e Vublk proWKY �m� <br />ACKNOWIEDOEMENT OF CONDITIONS ,r�///p �� <br />I� � �I�GC_ ��'"`,Nu/TF <br />SIGNATURE OF APPLICRNT <br />CALL FOR INSPECTION � <br />pOST ON 259-881 � <br />JOBSITE 24HRS.BEFORECONSTRUCTION , <br />� <br />� <br />J' <br />� <br />