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- - --- --- -1 <br />�""�" APPLICATION FOR PUBUC WORKS PERMIT <br />�` ' TYDe or Orint Geer1V with ink <br />PRESS HARD • YOU AfiE MAKING COPIES g � 3 p 3 <br />PUBLIC WORKS <br />E,/VERETT,WASHINGTON <br />yy OWNER ❑ AGENT <br />DATE �II�� O� <br />APPLICANT/FIRM REPRES�NTED <br />PERMIT NO. <br />BLDG. DEPT. NO. <br />ADDRESS ��n / �J OfI Kf' S CITY ���LTELEPHONE � (2��_� � <br />SYG • <br />HEREBY APPLIES FOR PERMISSION TO �_�!7 � ��!P f U�-` L✓/� � <br />ATTHE FOLLOWING LOCATION �i �� �7 O��£ S �vt.IQ l I <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the followi�g as applicable: <br />` Property Iines and atreet identity. ` Topographic changes requiring cuts and fllls <br />' OutHne end dimensions of existinp and other than normal foundation. <br />proposed atruc��•res. * On-site drainage systems when required. <br />• Existing and proposed utilities. ` Erosion cnnErol met ods when requfred. <br />• Centerline of abutting right of way. • Nonh"arr vi � � <br />� • � l"`� <br />sfpneNre ol Aoo�icant <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />j... C 1 <br />I1� 4X�y��N COMN+ON C�f�J�rVP ����f„vw�� q� N0�44 <br />o.,✓ �.n.r be . r....o�.� c...9 �eP\ac.z� <br />� . � . . �G..�i.n.tic i.� be. io�� � <br />�:: Z.. Ne,,,� b n.: e,,.; a —. <br />� „ <br />. . � . � ,`ew�ovl �'� �5}i�` S�c�r.,,e.\� u�� fc�1o�..f �o <br />J <br />C�(��1w01r� <br />w..+, r...nvy . . <br />:: .. :.: . �e.�o.,a� w.��E b. ,..ade .�k ...a,rsF- enPa..a��� �o,.:� <br />�..... SQ�''-c � a�F.� 5cmre a+wrl� �r <br />___... . . .1�. . . ET\D�1M� .CN.f i�. A+C.y. .bQ . .�NociCl � ptT . CaS. q��fOJ�cD'�^� <br />l � <br />. . . . � .��n� Prbl�� l.�+o ��c S ��+S�Cc �ar� . .. <br />1::::::;.. <br />::; . <br />__._�,____.._�.� ,_ . <br />I. . . � . . <br />� . . <br />/ <br />� � • OL'�—� . . . <br />r� lao ,, �„ <br />-r�,� - �,,,,+�� - <br />� <br />e undersiBned owner �ereby agiees to hold and save harmlase <br />�he Cily ol Evere�I Irom eny end ell Clelme fOr dem�pe0. �Oe10. <br />erpenses, or causee ol Bctlon I�et may er16e Deceuse ollnet�IletlOn <br />� antl msintenence oi the imOrovemenl or ot�er ri0h1-ol�wey uee <br />hereto ePP�ietl lar and turihar egreee to remove eeme upon nollce <br />Irom the City an0 to replece public property demepeE theraby. <br />G--T� S -�/ <br />� Dy/f E ACKNOWLEDGEMEN O.CONDIJIOf1S <br />�1/ � �c cj��..-h-�^-7�� `�' `A�-,,� <br />DAT� SI�FIATUR OFAPPLICANT DATE <br />PERMIT IS VA�.ID FOR 1 <br />\. EXPIRATION <br />CALL FOR INSPECTION il <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION ��', <br />