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""rc" APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or Prinl clearlY with ink <br />PRESS HARD • YOU ARE MAKING COPIES g a 3 8 0 <br />PUBLIC WORKS PERMIT NO. <br />E�RE''T, WASHINGTON BLDG. DEPT. NO. �°?/�� }�� <br />�� OWNER ❑ AGENT DATE �,.���� <br />APPLICANT/FIRMREPRESENTED �a,1�,_B�P�Aw�1L <br />ADDRESS ci,�0� I7�Y1[� PI 5��• _CITY ���'�'F�L IELEPHONEI7�'7�bS <br />HEREBY APPLJES FOR PERMISSION TO � 4"'�' S� � U c'f' Z v� CO�Grc� LQ f I VC. <br />ATTHE FOLLOWING LOCATION <br />,3 0�/ v e S �-. <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br />* Property Iines and street identity. ` Topographic chs�nges requiring cuts and fills <br />' Outline and dimensions of existing and other than norrc�al foundation. <br />proposed structures. ' On-site drainage systems when required. <br />' Existing and proposed utilities. * Erosion control methods when required. <br />' Centerline oi abutting right of way. ` North arrow <br />4Sl�N� � 2�i � �b �. <br />Signeture ol Applitenl <br />PUBLIC WORKS PERMIT <br />�CONDITIONS: _ _ . _ - - . . —J / <br />. . . . . . . %. /Y�f /'.00.r- GlIC!/r1T . iJIH.S.% �� T/377/nrW /n � Al[�� .SNl���/'• . <br />I. � . . . . .�.. /Y�� .GVV•-/c . iYJw1i-� � e� /n Lun�iw+onrf c..� � bpc� Ltio��.5 . . . . . � . <br />. . . . . . . � . .�Sisn .9 �.OrtSf/'KCTIOn .'.$'�R..c/iIr✓S Y ..Spl.-^�7i[r.7TONf . . <br />�. <br />H.� .�ii�f-�vif�o:, oi�e.�ir�r�w�y w,�:.� -�ie ��5/rr �c',5lrr-o�•o..py <br />_...__._.. m�sf. 6.�. pq„�. � � . <br />�::;::::�::.' : <br />: _� : : . �' . . � . . -�-. , . fi-- �-- .-; _._ _ { -;--- -,-- .�t_ : _ : <br />�..�__._:`�:: :::'::: ..:: :: �.:::: :::�..�i ..::��: <br />- :- ; :-:- f-.--: : .- I . . : � ___ }' _ _ . _; . . . _ . . . � . . . . . . . . . . <br />, . . . . . . . . . �: �Y : . . . . . , <br />.�....... <br />I +f . . <br />. . . . .�I. :�_�_�_�___� <br />� '�T�~� . �, i ,, The undersigned owner hereby agrees to hold end save harmless <br />, . `�, , , , . . . . . . � . . . . . the City ol Everatt Irom eny ana ell clalms lor demapeq coste, <br />�� . . . j . . . � � � - � . - � � � expenses, or causas of ection t�at may eriae becauaa of inalellatlon <br />, . . . . . . _ . . . . . . . . . . . . . � and meinlenanca ol ihe Improvement or olher nq�4o4way use <br />����� � � - �� �� hereto applied lor antl luriher aprees to remove same upon notice <br />�- � _ � � trom Ihe Cily and to replace public pmpetly tlemeBed ihereby. <br />/ %2 z 7 z <br />'1�'� O UC ON DA ACK WLEDGEM TOFCONDITIONS <br />/ <br />,� ��� S' /G- �..s M ��s��-3 — <br />APPROVED AS CONSTRUCTED DATE SIGNATUR APPLICANT ` f�ATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATIQN <br />POST ON CALL FOR INSPECTION <br />JOBSITE 259•8811 <br />24 HRS. BE�ORECONSTRU�TION <br />