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r — <br /> _ _ - y <br /> �— � <br /> ��'° AP�LICATION FOR PUBLIC WORKS PERMIT <br /> Type or print cleady wilh ink . <br /> � PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. � I O�'I <br /> PUBLIC WORKS � <br /> EVEREIT,WASHINGTON BLDG. DEPT. NO.��Q� �� � <br /> � �OWNER ❑ AGENT DATE �_�z __ . <br /> APPLICANT/FiRM REPRESENTED �«�S �1NC�� ��UC__ ___ �', <br /> ADDRESS �� S.E. CJH�Tj �f1tL !J�� cirv EG�«'crJ TELEP �ONE -�-�����>Z <br /> , HEREBY APPLIES FOR PERMISSION TO /����CC p�S � �{f//)E (Gk.l'�E� �/�/Cll/�/ <br /> • '/ � (003—l�eta �ene /,r�b1/S,/.n; �. <br /> ATTHE FOLLOWING LOCATION L�% l-��1 l�Ek�«iUF �f�/�S <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the tollowing as applicable: <br /> : ` Property 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 of abutting right of way. ' Nort arrpw <br /> ��� � � <br /> � ' Si ature ol Applicant <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> ' : : : : . : /. . . l?oo{��vp dra.;na�� mus f be c'onf i'ol%c� : <br /> . . . � <br /> . . . on 'the / of, `- � <br /> .. , : <br /> , :- - ; <br /> ' l. : : . ��: f�ny c�amay e or ar�aka9e fo �u,bi� � ��� W, <br /> ! j :.: : Uccur'ii�q ,�Ue. to Cohstrucl�lon n7ust �e <br /> _ : : . Y'e�n� 'r.ed. : hy : bcti ld er <br /> . � "`a: <br /> : . : . 3 : Debrc's. tra c k e c� i n fo p�+b 1 i c, %�. � l�✓, 7 ro m � <br /> I � � fhis ConstrucfrQi� sife �s fiv be Clear�ecL <br /> � <br /> � i - : . � � � � - ' .�i-' - �y The undersigned owner here0y agrees to hola and seve �armless <br /> ' :�� �jlP d� !l�/�', ' ��� / - � Ihe City ol Everelt tmm any ana au claims lor tlemages, costs, <br /> "� � ,',1 (n�� � /� expensos,or causos o/action thel inay arise beceuse ol Installalion <br /> '�� '. � . ,�� (,v/�T�(Z �,��V�� UqK.�y�� .S � antl maintonance ol the improvement ar ot�er righl-obwey u.e <br /> i � hereto apD�ied lor and lurlher agrens lo remove same u0on nutice <br /> � v ;' gE k'29�pEC� eGER�UBD � �I. �p „om ,,,e City end to �oo�a�o puhlic ' <br /> properfy aameBed thereby. <br /> �., � ��,/ <br /> � ��{���" � �. ,��G�c-Z .a <br /> � ������YiOVED FO-R C�N � T-ION � D�TE�� �'�,-ACI�Z OW EDGEM N�CON�ITIONS �� <br /> �, " , z- � L <br /> - �_,J. � �`� � ���' _ � �- � �� �/_ , <br /> APPROVED AS CONST �TED - DATE SICiNA URE OF FLICAN i DATE <br /> PERMIT IS VALI FOf� 1 YEAA i C.4LL FOR INSPECTION <br /> POST �N 259-8811 <br /> � EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION � <br />