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<br /> le`"" APPLICATION FOR PUBLIC WORKS PERMIT
<br /> , �� TYPe or Prinl cleady with Ini. fJ �
<br /> i � PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. `� ���
<br /> PUBLIC WORKS
<br /> EVE}F ETT,WASHINUTON BLDG. DEP7. N0._ ___ ,
<br /> ', �'UWNER ❑ AGENT DATE ��L�� ���J�
<br /> i APPLICANT/FIRM REPRESENTED _,G.�4<-.L.rJ,r2�11�!�.f���'��-Qa`4=�/iy�`
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<br /> ADDRESS � " -�u,��,�� ' ' �CITY ��,,.,�-y�1'��'t�TELEPHONE 3�,' -�O/-G
<br /> � HEREBY APPLIES FOR PERMISSION TO �f�_ r;--•�_,i�;:`��,�/<, �c.,z'- �L�� �� n��-��'� �-%-� ��,,
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<br /> I �&,c'<---' ' - i. . - ,
<br /> AT THE FOLLOWING LOCATION -'_v.�_�,�=,.�,_��,._.�.�i���-r- �J�� �i't»Q
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<br /> IAttach five(5)copies of preliminary plz.ns tor proposed work.Draw to scale and show tha following as applicable:
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<br /> ' Property lines a�d street identity. ' Topographic changes requiring cuts and fills
<br /> ' Outline and dimen�ions of existing and other than normal foundation.
<br /> proposed struc:ures. * On-site drainage systems when required.
<br /> ; ' Existing and proposed utilities. ` Erosion control methods when required.
<br /> i ` Centerline of abutting right of way. • Nortn arrow
<br /> -L% .i.: ii �,G•rrc,E.i Y.r'r, / �
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<br /> — N.--� Si na icolA �, Rt�
<br /> , PUBLIC WORKS P R� I �
<br /> I CONDITIONS:
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<br /> i � �- ���iP. :S,/e 0��1y. J�2e CoscodP ,�J«q ��us. C-Z }yr-�rC-/:
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<br /> �; a� � : l � : : � . : : : . i : : : :
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<br /> �� � � � � � � The untlersigned owner hereUy a9rees lo �old and savo harmless �I
<br /> i , . , , . , . Ihe City ol Evnre'! trom any ana nu ciaims lor damagas, costs, �
<br /> eMpenses,or causes ol acf.�n t�at may arise because o'instellation I
<br /> ,– .. . . . . . . . . and mainte�ence of Ihe ir,iprovement or o�her righl�ol-wey u6e �
<br /> �, ; � � � � - � herelo epplicd lor and lunter agrees lo remove same upon natice
<br /> Irom �he Cily antl b rrpL�ce public property damapeA �hereby.
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<br /> I OVE�bRCONSTRU N E ACKNOWLE GEMENTOF-C - ITION$
<br /> ' �7 «�i'� r.d7Z.•i _�i./.r���'�. i
<br /> ^ � APPROVED AS CO RUCTE Z DATE SIG ATURE O r�PPL N - DATE �Z_�� .
<br /> PERMIT I� VALID FOR 1 YEAR CALL FOR INSPECTION
<br /> i POST ON ' 259•8811
<br /> I � EXPIRATION 2�-zz—P'� .iOBSITE 2,qHR5. BEFORECCINSTRUCTION ,'
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