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"'"�" APPLICATION FOR PUBLIC WORKS PERMIT <br />� Type or pdnt Gauly with Ink <br />PRESS HARD - YOU ARE MAKINCa COPIES pERM1T NO. Z Z' <br />PUBLIC WORKS <br />EVERETT, WASHINGTON �/7�2�Cj _ �/— ' BLDG. DEPT. NO. <br />❑ OWNER ❑ AGENT DATE '� �� �, �, � <br />_ •�-�/ n i � <br />APPLICANT/FIRM REPRESENTED <br />;' <br />ADDRESS <br />HEREBY APPLIES FOR PERMISSION TO <br />ti <br />(1TTHE FOLLOWING LOCATION <br />/��-�'Lc-� TELEPHONE3���`S�d <br />Attach ffve (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 of existing and <br />proposed structures. <br />" Existing and proposed utilitfea. <br />• Centerline of abutting right of way. <br />L�3 <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage sYgtems when required. <br />• Erosion control methods when req ired. <br />" No h arrow <br />nNurc f Appliant <br />IT <br />• � __ _. _ <br />. : ' : . . ; : : :-�. ; : L EXPA��51otJ Joi N� R�Q��tL�� A-T � <br />• <br />. . . . . . : . . . . . . . . v��. LEi�GYt}: : : . <br />. , : PRaP.�RTY LI NE F <br />� .. •_. ::-- :.. _._' --- :: <br />._. � D�� <br />. <br />. . . , _ _ _. <br />` .._ _. . <br />I ._.- r___� i:::::.:i �:: '.:�, , � _::':: <br />. � 1 <br />: .. _. .. <br />, � __ _ _ _ , <br />:,.: . : :j:. .:::� :'.: l . : ::, :: I : � : <br />. . �. ,�� �_ _--�---_--�__---_. . _ . . _ _ - <br />. <br />._. ____ ______�.___._ <br />i - - : _ . . ; . . : ; - . . _ _ , . . . . . , . . . : ; : : <br />..' •'. , ...... <br />--- .. ........... . <br />• . . . . . . . �',6 NSTR�TC'C"l0 <br />� j� j �{''�1 `'� <br />� � �.--.-- `� - ----- � � --� �/ ' '-"�� �"��' ` � � � - � er hnreby eqre�to holA entl seve harmleee <br />-f.- .l . . . . . . . . �. - . The untlersi9ned own <br />`� the City of Everact trom eny ena ell clnimt for demeqe�, coet4 <br />� • � � ' ' � ' � � � � � n `,, ezDensea. or ceusea ol action t�at may erise bec�uee ot InNdlUlon <br />'• �'��� tC � �� yY� ��6enC melntenence of the Improvemenl or other tlpMol•wey ute <br />- ��� � hefetu Bpplied for end �urther 00feee lo femo�e sema upon �atiGe <br />irom tha City end to replace pu611c property deR�ped theroby. <br />._ _ • . . . . . . . . � . _ ��. � . <br />Z� nv� � 1 <br />PERMI� IS VALID FOR 1 YEAR <br />' EXPIRATION <br />r <br />/�ACKNOWLEDGEMENT OF CO ITION II <br />� ' <br />IGNATURE OF LICANT DATE <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />