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.` <br /> "" —___ _.____—_____ _. _. .. __ ....__ _ _ . . ._ .. . . ._ _ . .. _ _._ _ _________�—_-F <br /> e°� APPLICATION FOR PUBLiC WORKS PERMIT <br /> � <br /> Type or prinl cleady wilh inh <br /> PRESS HARD-YOU ARE MAKING CGPIES pERM1T NO. ;� a ' <br /> PUBLIC WORKS .-�- <br /> i i <br /> CVERETT,WASHINGTON . - J }. J BLDG. DEPT. NO. �. �� �r �' � <br /> � ❑ OWNER ❑ AGENT DATE _ _,_�_,___ _ __ <br /> ' APPLICANT/FIRM REPRESFNTED ..;.�_�_�.,�_•.t..�, _ _ _ _ _______ ___ __ <br /> ADDRESS ���• � � �_��� � CITY ___�,�LTELEPHONE�5� '- �-� '+'� i <br /> �� HEREBY APPUES FOR PERMISSION TO ��r-.� :�w �,�� .� �',� ,� ,� 1 -�.�i+_J'._�; ..�� / ��' <br /> � ) :'— . <br /> , / '� =J1.q—��/---` � //'• _ — y <br /> AT THE FOLLOWING LOCATION _ �"_______,_,.__ ' _��.�__ _ <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 changes requiring cuts and fills <br /> ' Outlir.e and dimensions ot 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 abuttiny right of way. ' North arrow \ <br /> . I /�_- � rC L / <br /> . =LI�'_- �_�� 1,J f ', i- �r � <br /> — — -�— <br /> Siqnalu�_ol AppliCenl <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> 4. . , _ � : . . , „ _ „ . i � _ . _. � � �i'�P�a' . <br /> , . <br /> i <br /> i . . . . . <br /> f–. __. . . . . . . . . . . . . . . . . . . . . _ . <br /> � . . . . . . . . , <br /> �_ ._. . . . .. . . . . . . . . . <br /> � . . . . . , <br /> �-- :_. . . � _ . . . . . _ . . <br />� <br /> ihc un�fei5�gneJ nwnci hereby apiees :o �oltl antl save harmless <br /> ihe Cdy OI EveiCtl tinm dny Bna 011 clnims lof tl8mages, cost5. <br /> e.Venses,o�wuses ol aclion that may arise betau5e ol installution <br /> � � � � and mainlenance of Ihn improvement or oiher right�ol�way use <br />�� hCrcio applietl lor and lurihef agrees lo femOve seme upOn nOliCo <br /> I) <br /> I _. _'_"__ . ._."� , <br /> Irom Ihe City and m re0�ace pu0lic prapohy Aamapod Ihereby. <br /> _ .% �/ <br /> '�i;l.-✓..�.�•--`�,'.�:i%--G�----- �� �-1 '��- _. <br /> ROVED FOR CONSTRUCTION DATE ACKNOWLEDGEAIENT OF CONDITIONS <br /> _ 1� <br /> / <br /> ��- ---7- zo .�-Z .�_�:-' i�-=-i '-� r, , , � _ . <br /> PR ED AS CO TRUCT UATE �SIGNATURE OF APPLICANT DATE -� <br /> PERMi7 IS VALiD FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> EXPIRATION JOBSITE 24MRS. BEFORECONSTRUCTION -' <br />