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�-- — <br /> —� <br /> ---- N(�� �CG � �,: %5� ciC�.a!e o Y ✓�'i�� � r�i-,��S . <br /> everctt APPLICATION FOR PUBLlC WOR�S PERMIT <br /> Typ¢or prin�clearly wilh ink " � <br /> � PRESS HARD•YOU ARE MAKING COPIES �,Z /{ti/�. <br /> PERbt1T NO. � � <br /> PUBLIC WORKS <br /> EVEREIT,WASHINGTON � P� BLDG. DEPT NO. � <br /> O OWNER ,�AGENT DATE __���'�JL _ '— <br /> A'PLICANT/FIRM REPRESENTED —��uN��_- �1�=Z�EG'�[AL..l']AV� .LIC��1UQ�.I <br /> ADDRESS ��n�� �`-'�' �%r� �'•�• CITY ��re� TELEPHONE_ <br /> HEREBYAPPLIES FOR PERMISSION TO —G_������:V�-T a `f�MG'�/ r'�x�'�'�1�11� I a�7i' C�F <br /> Z° A i. E�, r`�'.k' ATTAc�-1�"D P�AN ._ <br /> ATTHE FOLLOWING LOCATION ��AM� AS Q,�pV�. <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> ` Prcperty lines and street identity. � Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On•site drainage systems when required. <br /> • Existing and proposed utilities. ' Erosion control methods when required. <br /> ' Centerline ot abutting right of way. • North rrow <br /> Sign ureotApplicant <br /> coNomorvs: PUBLIC WORKS <br /> � I 1 1 �J r � � a �= <br /> ��� ( 1���'(' ��! [�f�i K Ivl` I �.. Y 1 (i=� ,�..� P.W� C1Yn �.�t2` l� �., �. . . <br /> 1 J J �_.'_r ' <br /> ._.� . . '� P.,�_/�crqr� U��.\� «.-�J.' ...�C.� ` 11 '�c�t•�-io..' `3u.r , .. <br /> i <br /> �. .; ��,��c��N 1 )('r w�-4 S -�v r •-�in'���u rC' c.1��r�ct•1-�w_ /�Pr w�0.�r•��� . <br /> r il -! . 1 J � <br /> I -�— (�J`G�N�� •. l �LLr���\vi� 1U� l� rP�(�,ir�l 4�� + <br /> 1 J«�r P�tiu.i�c'S <br /> � �, ' ; «„�, ► �� >_.h.._.H�<s' -� ���,,�.,:�I , .-��I�,, IN ��' <br /> -+-,- 1 1 � I <br /> - � -�-� 'Uv�c�Sccl� �... la... Ui � l � G1S�, l�c� !rC- �.�2.c��11 �.:�- `��14�.+(�'Ii�n` <br /> . ,"'�"_�'j—; .. { �. � 1 . <br /> . <br /> �:_�.._.�� <br /> .}. i . <br /> ...1_i_.r.L. . . . _ .. ' . <br /> �1_!._�L {� '_' ' i i �1 '�___,'��_:. <br /> � 7 <br /> .�� I ._.� � �f-�-� l� L l.-. � 1 � ; !� The undersigneA owner hereby aBrees lo hold and save harmlene <br /> . . . . . . �-- -_ - �hC Ciiy pl EvEf¢II t�Om 2ny end 211 CleimB �p! dslIIBQB6, CObtl, <br /> " ' - � ' - " ' BAPfI15Q5,Of CdYSPB O�HG�lOf11h81 T3y 8(IBB bBW088 D�IIIlIlIIlIf00 <br /> and maintenance ol Ihe ImOrovemenl or olhar riph4oFwey usa <br /> hereto applied lor and lurther egrees to remove same upon notice <br /> / / IrOm Ihe Cily and to replace publiC property demepad Ihefeby. <br /> �-���'��y-�� _ <br /> ��A PROVED FOR CONSTRUCTION D TE ACKN W EDG M NT OF CONDITIONS <br /> i`�1.�� i - 1 .+ <br /> , I K L.- <br /> AP ROVED AS CO S UCTED DATE SI NA RE PPLI NT p7 <br /> PERMIT IS VALID FOR 1 YFAR pOST ON � FOR lNSPECTION <br /> JOBSITE 259•8811 <br /> j EXPIRATION 24HRS. BE�ORECONSTRUCTION <br />