|
everett qpp�,�CATION FOR PUBLIC WORiCS PEFt�FIIIT
<br /> �� TVI`e or print cleadY with ink -
<br /> PRESS HARD•YOU ARE MAKING COPIES � �,�
<br /> PERMIT NO. _._�-
<br /> PUBUC WORKS
<br /> EVERFTT,WASHINGTON �_ / �7 6LDG. DEPT. NO._^.= /�'� '` '
<br /> �{OWNER O AGENT DATE . / ��'_�_ _`�
<br /> —
<br /> � , ;
<br /> �
<br /> APPLICANT/FIRMREPRESENTED ..�����5 t'"�S-` ��. . .� <<-�C_ _ -_.._
<br /> ADDRESS ���' ✓� F__�r%(: F"i_7T/yI��L (.�/ll�I ���Y �:"I�E�Pt'Y"/ TELEPHONE % SS�y�%.�_..
<br /> HEREBY APPLIES FOR PERMISSION TO ��USTf��L o�����(/ / _�✓l�r i� �,Pi Ur-Zdn._._
<br /> --- - -- -- -- ---- /
<br /> ATTHE FOILOWING LOCATION _���..��-_�___L/�L�-.i,�:.,c_�d_'L��^"�-_rD�Z���lG; I F��_a I,�a S �� -�
<br /> - `�`� ,�
<br /> Attach tive(5)copies oi 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 (ills
<br /> ' Outline and dimensions of existing and other than normal foundation.
<br /> proposed structures. ' On-site drainage systems when required.
<br /> ` Existing and proposed �tilities. " Erosion control methods when required.
<br /> " Centerline of abutting right o( way. l� Nortl� arr w ,
<br /> .' �' � � /�
<br /> -`��'`11,, �, ��.c__- —� - _ __
<br /> _ •.$i3naNre ol APPliconi
<br /> PUE3LIC WORKS PERMIT
<br /> CONDITIONS:
<br /> r ' ;-
<br /> . �. ���ov �1 �'r= �J �} ���." , ., jr__ r�,,,,. �_> � .. < <..,, �1 ..� � i �.� .,.. •� 6-,� j �.,
<br /> ;j� A...� c�A�pSC or brea�a `�/1e.. '�-� �46�ic. ��5�-+-•o� • w,.-.�
<br /> 1 . . . . . . OCC1AfY1V1 . �D .�� C-ONS.TCHGilOi1 �NSr .�C. �f'i:�. � i ' I �.
<br /> b,� b., ,i�P�
<br /> .3� �ebr�� --y-ra �IcP�J �� � 'P,.�b�;� �51,�- -b-F - wQ7 ';�:,.
<br /> I I I r
<br /> . . _Lyt�t . Gavia'�' fwG� w-, Si '! P IS '� t�P P�tw.� .-��' ... .
<br /> _ `J.
<br /> , ,
<br /> i . �
<br /> . � . . . . . . o
<br /> i ✓/� ����:��E.1 C�c'-e a''L"-��.fi�'l, �
<br /> ' . .Ue �e. �� . ` tse�. ee��lL_C�7 �•G r.ti�.�Uz2-7
<br /> �� � G . �L��. :e�, err �.��-E` �°-��� -����-;��C'�C � � "�� �;i-r��.
<br /> � � / � � / ,, � � -
<br /> ' _ ,//� �rli�L`C�7:r7Z�L��C� !C -'Z�L,L.cZ�!'
<br /> , �" i� /, �; �� The n eJnigne , ner hereby a9rees lo �uld anA save harmless
<br /> jr'.f'�-�i� �Z'LCi`L 1��7�A�e I bl�ver tl irom sny ana �n cinims lor aameges, cosls,
<br /> S � � exp=nses,or cacses ol scllon t�nl may arise Decnuso of inslallalion
<br /> �- _ � Z � or ! main�•�nanr.c ol Ihe improvenenl or other riyh4oi-way uso
<br /> . . . . � � h�'trlu G,'plr J I:.r and lurih��r ;fgr¢C5 IJ Il'n10�'C SemP upOn OO�ICE
<br /> � � Iroia 1� : Ctl; �nd tu u,olnr�, pubhc P�opertY tlamaged IherabY.
<br /> _ �����Y .1 J�� 7
<br /> � �...-� j/,-�,�-� ,// 'F �
<br /> .-APPfi� VEDFORC TRUCTION DATE ACKNOK'LE-DGEf.fENrOFCONDITIONS
<br /> . - �i/�' � ' �
<br /> �•».fe<.-. _. , _ -=e:� U_�� �_ 1�- = _ _
<br /> _._qpp(igyE{FAE�66WS� !l4TbCfj , DATE �SIGNATUREOFAPPLICANT . .. -_ -_ . DATE
<br /> PERMIT I� :ALIO FOR 1 YEAR pOST ON CALL FOR WSPECTlON
<br /> .._, 259-8811
<br /> EXPIRATION '' ��� `f-� _ JOBSITE 24HRS. BEFORECONSTRUCTION
<br />
|