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, <br /> e"e`�" hPi�LICATION FOR PUBLIC WORKS PE�iMIT <br /> . � TyPe or Print UcadY wilh ink <br /> PRESS HARD•YOU ARE MAKING COPIES � -i �� q <br /> I PERMIT NO. _"—f—�—_ <br /> PUBLIC WORI<S 82/10286 <br /> ' EVERETT,V�ASHINGTON 3�2�87 BLOG. DEPT. NO. <br /> � W;OWNER ❑ AGENT DATE _ ____—_ <br /> �, APPUCANT/FIRM REPRESENTED Hillis Home� Inc. _ _ <br /> I ADDRESS fl�� 7�• �verett Mall Way C171,Bverett TELEPHONE ��5-4492 <br /> HEREBYAPPLICS FOR PERMISSION TO _ I'�etTll driveway <br /> I o <br /> -- -- �/,�/ — -{ <br /> I ATTHEFOLLOWIIJGLOCATIpN Lot 131 5/ C� ��pr�/Phe ,/v �1'_s � _ m <br /> � <br /> f <br /> Attach five(5)copies ot preliminary plans for proposed work.Draw to scale and show the following as applicable: ,� <br /> � � <br /> ' Property lines and street identity. ` Topographic changes requiring cuts and tills ;,, _ <br /> ' Outline and dimensions of existin� and cther than normal foundation. , o m <br /> proposed structures. * On-site drainage systems when required. m o <br /> ' Existing and proposed utilities. `Erosion contrcl methods when ,equired. � � <br /> ' Centerline of abutting ric�ht of way. �' North arrow / � <br /> I I i' � /_ � -� � <br /> �'i � fU� ( <br /> =y-.��%���--- m .. <br /> Signa W re ol Applicanl ,r,, � <br /> C <br /> PUBLIC WORKS PERMIT � _ <br /> --1 N <br /> < <br /> CONDITIONS: <br /> oz <br /> � a <br /> /� -� m <br /> r s <br /> m � <br /> I . . � � .� . v � <br /> . 1 . �/ �m <br /> y c in <br /> �jQ : � <br /> ', ..__..-._. . . . . � �, � 7 !�-� J z n <br /> � . . -i r <br /> , . � m <br /> n <br /> � . � . A <br /> I �.�_._. . . � <br /> . _ <br /> �! . . ! . . � . . . . . : . . . . Z <br /> �, , � ._._ _.--L:�_._�....�. ' .� __. . � . . <br /> �. _ : i I .� ., � � ,� . �� � - . 1` . . : . . �- �. in <br /> � . . .. . ! . -i�� . . . . . . . <br /> _ ' l _— ' '- ' 1- . . . . o <br /> � . _ � . . � . . � � <br /> m <br /> i �_�i_:._,+._..' _ . ' _ . . . . . . . <br /> i �� T'�� undersipnetl owner hereby agre�s to hold end save harmless <br /> I' . ; � � , the Cn; ol Everml Irom eny and r.n Ueim� lor Aamag"s, costs, <br /> � � , . , � , , , , . . 3MpL•uSeS� •ca�ses o�action Ihat mey erL•e because ol installation <br /> , . . . . . . _ . . . . . . . . . . . a�d me' � nce ol Ihe impiovemenl or olher ri;7h4oFway use <br /> � . . . • • hmelo t � lo;and lurther ngr��.es to remove semo upon notice <br /> � i . -> Imrn th� � und tu replace punlic pmperty damaBed Ihnreby. <br /> ��-�� �L'+fi1�-�O L �I <br /> � �PhROVED FOfl CONSTRUGTION DATE ACKNO LEDGEME1JT OF f,ONDITIONS <br /> i : <br /> � � ' � / �li,-, i ' <br /> �}__ �: .G 1 1_Ir' _�"-_ <br /> APPROVEU AS CONSTRUCTED DATE SIGNATURE OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSP�GTION <br /> POST ON 2yg.gg1 � <br /> EXPIRATIQN '� �� `� ' ___ �OBSlTE 24HI�S. SEFORECONS7RUCTION <br /> , <br />