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,. <br /> � <br /> ., <br /> "'°'°" APPLICATION FOR PUBLIC VI�ORKS PERMIT � <br /> � TYGe or Grinl clearly with ink <br /> PRESS HARD-YOU ARE MAKING COPIES g� 3'.> (� <br /> PERMIT NO. — <br /> PUBLIC WORKS - <br /> . �E ERETT,WASHINGTON 1 Z� z_ BLDG. DEPT. NO�� ��'s <br /> OWNER ❑ AGENT DATE .�1___ _.__--- <br /> APPLIC.4NT/FIRM REPRESENTED _ ��/---��'-�j�`-''��----- <br /> ADORESS � � —� S C" —CITY �����S�TELEPHONE ��� ,��' <br /> Sl!-ll?L� W ZS`("Ci�1I <br /> HEREBY APPLIES FOR PERMISSION TO ��-�g`� -- - <br /> ��,_lL"l �-��-Q�`'-=�-- <br /> ATTHE FOLLOWING LOCATION -S.]-��� 3 r� = �—' ��� Y <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> " Property lines and street identity. ' Topographic rhanges requiring cuts and fills <br /> • Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. '� On•site drainage syst ms when required. <br /> • Existing and praposed utilities. • E 'sion control met� s when required. <br /> ' Centerline of abutting right of way. ' ��rrow � <br /> i �Ltn <br /> sipnatum o�Aov��wnl <br /> coNoirioNs: PUBLIC WORKS PER IT <br /> /, Fx i5a �.; �. S . �,�e ,n,.�ier_ �ro�05�.� �r.ue �,.R t� �ebc( �e <br /> {__�:...:._j._�. . AOW�Iva<. Sr e���.._� Gi�n� 7N0.1 �Oe 1J ��..Efrtdl � 'b10�- <br /> � .1,� ol d�J��, (3,. � �,,� <br /> � <br /> � . �iz��oSr�� �/trJ('wa� S.�ct// �e �o iiiS�: �K '�f�n.,c <br /> ,3 �ncl/lf cue� / �e �?c/�.T'�/✓t /s�rPe;Y- Cr"��e✓ ��zie <br /> I . � � �o ca��riv.-� Cti h P�t t�iT GYo SSc i p�?�� �'9/a`-' / <br /> F <br /> �i�� r <br /> j . / <br /> . , � .. �-.i...: // I r�'�f �i-'0 i o�� p� �T'-C' �/"/Ur''n-"tN /n d-�[P �ic�a�c <br /> �/i� rnWs�- fit ,pisvP�C�. I <br /> !i <br /> � � The untlersigned owner hereby egrees lo hold BnC a�ve harmleee <br /> � ' ) �he City ol Everntl Irom eny ena au cle�me lor dame9e4 �«R <br /> � ��"��'�, y L' � •S''-�` l.' C�.��L��-' exaenses,or r.ausea o�action ma�may adsa tecauee of�ne�anatlon <br /> ��'3' � ,I nd mainlenance ai the Impravement or other NB�tol•w�Y u�e <br /> y h rato applied for and further aproe�lo remove same upon noticu <br /> � � � Irom the City and to replace public property dameqxE thereby. <br /> s---> ^ <br /> �-�' �i��/c�/1� f' �- <br /> , APPROVED FOR CONSTRUCTION /' DA K O ED E�iIE T F CONDITIONS <br /> _ _ _ _ _ b—76�-� Z— ' <br /> APPROVED AS CONSTRUCTEU DATE S TURE O AP L CA DATE <br /> PERMIT IS VALID �OR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259•8811 <br /> . EXPIRATION JOBSITE 24HRS.BEFORECONSTRUCTION <br /> ,_� <br />